NCLEX-RN : Ethics, Processing, and Care
Study concepts, example questions & explanations for NCLEX-RN
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Example Questions
Example Question #3 : Alcohol And Drug Abuse
A 42 year old man presents to the ER for alcohol toxicity. While taking the history, the nurse discovers that he drinks on average one fifth of vodka per night, and often must drink an additional 6-12oz to get "a good buzz." When he doesn't drink, he experiences tremors and feels unwell until he is able to drink again. When asked if he would like to quit drinking he states that he has tried unsuccessfully several times over his life. He knows that he needs to get control over his drinking because it is seriously impairing his relationship with his husband and their 13 year old daughter.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM V), this patient can be considered to have which of the following conditions?
None of these
Substance dependency
Substance abuse
Substance addiction
Substance dependency
The symptoms described by this patient put his alcohol use in the category of substance dependency, according to the DSM V, a more severe form of abuse than substance addiction. The criteria for this condition are:
- Tolerance
- Withdrawal
- Unintentional excesses in consumption
- Persistent desire or unsuccessful efforts to reduce or control substance use
- A great deal of time is spent to get, use, or recover from the substance
- Interference with social life
- The substance use is continued despite knowledge problems caused by use
Example Question #1 : Alcohol And Drug Abuse
Prolonged alcohol abuse can result in a severe deficiency in what vitamin?
Niacin (B3)
Thiamine (B1)
Folate
Vitamin C
Thiamine (B1)
Prolonged alcohol abuse can result in a severe deficiency in thiamine, or vitamin B1 by reducing dietary thiamine intake, impairing gastrointestinal absorption of thiamine, and causing impaired thiamine utilization in cells. Note that individuals who partake in prolonged alcohol abuse may have various other dietary deficiencies.
Example Question #1 : Alcohol And Drug Abuse
Which of the following symptoms is most worrisome in a patient undergoing alcohol withdrawal?
Agitation
Tachycardia
Bradycardia
Delirium tremens
Delirium tremens
Delirium tremens (DT) is a rapid onset of confusion seen during alcohol withdrawal. The symptoms of DT include altered mental status, autonomic instability, and even seizures. DT is also characterized by hallucinations such as the sensation of something "crawling" on the patient. DT is the most severe consequence of withdrawal and can be fatal if untreated.
Example Question #1 : Nurse Patient Relationship
Example Question #1 : Nurse Patient Relationship
Example Question #71 : Care
Example Question #41 : Patient Specific Care
Identify the disorder that presents the following signs and symptoms: numbness, paralysis, loss of vision, or other neurological symptoms after a traumatic or stressful event, without any identifiable medical cause.
Schizophrenia
Conversion disorder
Stiff person syndrome
Bipolar disorder
Conversion disorder
Conversion disorder is typified by numbness, paralysis, loss of vision, or other neurological symptoms after a traumatic or stressful event, without any identifiable medical cause. Schizophrenia, bipolar disorder, and stiff person syndrome all have medically identifiable causes.
Example Question #42 : Patient Specific Care
What is the best approach towards dealing with a delirious patient?
Frequent reorientation to time, place, and name.
Frequent sedation with benzodiazepenes
Frequent sedation with antipsychotics
Frequent 4-point restraints
Frequent reorientation to time, place, and name.
Delirium is an organic dysfunction of the brain usually seen in sick patients post-op. These patients need frequent reorientation to name, time, and place until the delirium resolves. Agitation, confusion, and difficult to control behavior is typically controlled with antipsychotics, however, they are not first line treatment. Restraints should be avoided at all costs.
Example Question #1 : Ethics And Judgment
Which of the following describes the professional role of the nurse in a healthcare setting?
All of these
Caregiver
Patient advocate
Assessment
All of these
All of these are important professional roles of the nurse in a healthcare setting.
Example Question #2 : Ethics And Judgment
You are a new nurse taking care of a patient with congestive heart failure. You see an order to administer 500 mL of 0.9% normal saline over 6 hours. Later on in your shift, you realize that you mistakenly administered 2000 mL of 0.9% normal saline over 2 hours, and now the patient is slightly short of breath. Which of the following is the most appropriate next step?
Immediately administer furosemide to diurese the patient
Immediately contact your hospital's safety oversight committee
Ask your co-nurses whether or not to inform the covering physician
Do not tell anyone of the error since the patient is stable
Immediately inform the covering physician
Immediately inform the covering physician
The correct answer is "immediately inform the covering physician." This is the correct choice because in this case, a medical error was committed, and the most appropriate immediate course of action is to let the patient's covering physician know, so that they can determine what effect this may have on the patient, assess the patient, and determine what, if any, immediate intervention needs to be performed to ensure that the adverse effect on the patient is minimized.
While it is possible in this case, given that the patient has congestive heart failure, and that they may have been fluid overloaded by the administration of excess fluids, that they will need to be diuresed with furosemide, this medication cannot be administered without the order of the covering physician, and it would be inappropriate to administer furosemide without their orders.
While your hospital's safety oversight committee may ultimately need to be informed of this incident, the most immediate priority is patient safety, and as such, the patient's physician should be notified of the medical error before anyone else so that they can best manage any immediate consequences of the error.
It would be highly inappropriate to not inform anyone of the error, as an unintended dose of IV fluids was administered and this can be dangerous in a patient with congestive heart failure. Any delay, whether due to not telling anyone, or to conferring with co-nurses, in informing the supervising physician would be inappropriate and potentially dangerous to the patient.
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