नर्सिङ आधारभूत – Fundamentals of Nursing MCQ
नर्सिङ आधारभूत – अन्तर्राष्ट्रिय नर्सिङ
Fundamentals of Nursing · International Nursing (NCLEX-RN, DHA, HAAD) · ४११ प्रश्न
४११ प्रश्न उपलब्ध। मोड छान्नुहोस्:
नर्सिङ आधारभूत: प्रश्न र उत्तर
सही लागेको विकल्पमा थिच्नुहोस्। सही भए हरियो, गलत भए रातो देखिन्छ; ३ सेकेन्डपछि सही उत्तर र व्याख्या देखिन्छ।
सही: ० / ०
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A nurse is documenting the findings of a client's skin assessment. The nurse observes that there’s a red, shiny area with minimal edema and a well-defined border on the sacrum. According to the Braden Scale, what is the MOST likely stage of this pressure injury?
सही उत्तर: ख) Stage 2
Option 1 is correct. Stage 2 pressure injuries involve partial tissue loss with exposed subcutaneous fat and/or granulation tissue. The description closely matches this criterion. Stages 3 and 4 represent significant tissue destruction, absent of the features described.
💬 टिप्पणी / गल्ती रिपोर्ट (०)
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A client with diabetes mellitus is experiencing signs and symptoms of hypoglycemia (sweating, tremors, confusion). The nurse administers 75 mg of oral glucose. After 15 minutes, the client’s symptoms are worsening. What should the nurse do NEXT?
सही उत्तर: घ) Monitor the client's blood glucose level
Option 3 is correct. Monitoring the blood glucose levels (BSL) is crucial to determine if the initial dose was effective and guide further intervention. While notifying the physician is important long-term, immediate BSL measurement takes precedence in this scenario.
💬 टिप्पणी / गल्ती रिपोर्ट (०)
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A nurse is preparing to administer medication via subcutaneous injection to a client. Which of the following actions demonstrates best practice?
सही उत्तर: ग) Palpating for the largest vein before injecting
Option 2 is correct. Palpation helps identify the subcutaneous tissue and minimize discomfort by targeting the smaller vessels. Option 1 creates pain and potential skin damage, option 3 increases the risk of bleeding, and option 4 does not have a scientifically supported benefit.
💬 टिप्पणी / गल्ती रिपोर्ट (०)
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A client is being discharged from the hospital after undergoing a total hip replacement. The nurse reviews discharge instructions focusing on mobility. Which of the following statements by the client indicates an understanding of safe ambulation?
सही उत्तर: घ) ‘I will gradually increase my walking distance each day’
Option 3 is correct. Gradual increases in activity are key to rehabilitation after surgery. Option 1 suggests inappropriate footwear, option 2 indicates reliance on others which hinders independence, and option 3 isn't a safe strategy for mobility post-op.
💬 टिप्पणी / गल्ती रिपोर्ट (०)
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A nurse is assessing a newly admitted patient with pneumonia. The patient reports experiencing significant shortness of breath, a productive cough with clear sputum, and mild cyanosis. Which of the following interventions would be MOST appropriate for the nurse to implement initially?
सही उत्तर: क) Administer oxygen via nasal cannula at 2L/min
Option 0 is correct. Oxygen administration is the most immediate intervention for cyanosis associated with pneumonia, addressing the primary respiratory distress. The other options are less responsive to the patient’s acute symptoms – rest can worsen hypoxemia, a high-carbohydrate diet isn't directly beneficial for this presentation, and aggressive IV fluids could overload the circulatory system.
💬 टिप्पणी / गल्ती रिपोर्ट (०)
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A nurse is assessing a client with a pressure injury that is extensively covered by slough and eschar. According to established staging guidelines, how should this pressure injury be classified?
सही उत्तर: घ) D) Stage 5 Pressure Injury
Option C is correct. A stage 4 pressure injury is defined as full-thickness tissue loss with exposed bone or tendon. The presence of slough and eschar obscuring the base prevents accurate staging. Options A, B, and D refer to different levels of damage not described in this scenario.
💬 टिप्पणी / गल्ती रिपोर्ट (०)
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A nurse is preparing to administer an intradermal injection (e.g., tuberculin skin test). What angle of insertion should be used?
सही उत्तर: ख) B) 30-45 degrees
Option A (10-15 degrees) is the correct angle for intradermal injections. This creates a small, raised bump of fluid beneath the skin, allowing for visualization and accurate measurement of the reaction. The other options are incorrect angles that would result in absorption into the systemic circulation.
💬 टिप्पणी / गल्ती रिपोर्ट (०)
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A nurse is preparing to administer subcutaneous heparin. The order reads: Heparin 10 mL subcutaneously. The available heparin solution is 1000 units/mL. How many milliliters of the heparin solution should the nurse administer?
सही उत्तर: घ) D) 20 mL
Option C is correct: (10 mL / 1000 units/mL) = 0.01 mL. A nurse needs to administer 10 mL, not 0.01 mL as stated in the question. Option A is incorrect because the dose ordered was for 10 mL. Options B and D are incorrect, implying administration of a much smaller volume.
💬 टिप्पणी / गल्ती रिपोर्ट (०)
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A nurse is assessing a newly admitted client who has been complaining of nausea and lightheadedness. Which finding would most likely indicate a need for further investigation?
सही उत्तर: ख) B) Client’s blood pressure reads 90/60 mmHg.
Option B is correct because hypotension (90/60 mmHg) in a newly admitted client with nausea and lightheadedness is a significant finding that warrants immediate investigation to rule out serious underlying causes such as dehydration, cardiac issues, or medication side effects. Options A, C and D are less concerning and do not immediately indicate a critical medical issue.
💬 टिप्पणी / गल्ती रिपोर्ट (०)
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A nurse is teaching a client how to use an incentive spirometer. Which instruction is MOST important?
सही उत्तर: ग) C) Advise the client to maintain a continuous flow of air throughout the inspiratory cycle
The correct answer is C. Maintaining a continuous flow of air during each inspiratory cycle with the incentive spirometer maximizes its effectiveness in expanding the lungs and preventing atelectasis. Options A, B and D are incorrect because they would reduce the efficacy of the device.
💬 टिप्पणी / गल्ती रिपोर्ट (०)
यी अभ्यास प्रश्न हुन्, आधिकारिक प्रश्न होइनन्। पाठ्यक्रम, विज्ञापन र नतिजाका लागि सम्बन्धित निकायको आधिकारिक वेबसाइट हेर्नुहोस्। उत्तरमा गल्ती भेटे प्रश्नमुनिको "टिप्पणी / गल्ती रिपोर्ट" मा लेख्नुहोस्।
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