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NCLEX NCLEX-PN - National Council Licensure Examination(NCLEX-PN)

Page: 14 / 15
Total 725 questions

The nurse assesses a client for physiological risk factors for falls. The nurse should conclude that the client is not at risk if which of the following is discovered?

A.

history of dizziness

B.

need for wheelchair due to reduced mobility

C.

weakness and fatigue noted when climbing stairs

D.

intact recent and remote memory

A nurse is covering a pediatric unit and is responsible for a 15 year-old male patient on the floor. The mother of the child states, “I think my son is sexually interested in girls.” The most appropriate course of action of the nurse is to respond by stating:

A.

“I will talk to the doctor about it.”

B.

“Has this been going on for a while?”

C.

“How do you know this?”

D.

“Teenagers often exhibit signs of sexual interest in females.”

A legal right to confidentiality of client information is waived when:

A.

a court system subpoenas information.

B.

a family member requests health care information of a client.

C.

a living will takes effect.

D.

the client is declared incompetent by the legal system.

While admitting a client to an acute-care psychiatric unit, the nurse asks about substance abuse based on knowledge that:

A.

psychiatric illness is more prevalent in addicted populations.

B.

people with psychiatric disorders are more prone to substance abuse.

C.

substance disorders are easily detected and diagnosed in acute-care psychiatric settings.

D.

undetected substance problems have no real effect on treatment of psychiatric disorders.

A patient has a history of cardiac arrhythmia. A nurse has been ordered to give 2 units of blood to this patient. The nurse should take which of the following actions?

A.

Prep the patient with pain medication.

B.

Notify the patient’s family about the procedure via the telephone.

C.

Decrease the temperature of the blood to be given.

D.

Increase the temperature of the blood to be given.

A nurse runs into the significant other of a patient with end stage AIDS crying during her smoke break. Which of the following is most appropriate action for the nurse to take?

A.

Allow her to grieve by herself.

B.

Tell her go ahead and cry, after all your husband’s pretty bad off.

C.

Tell her you realize how upset she is, but you don’t want to talk about it now.

D.

Approach her, offering tissues and encourage her to verbalize her feelings.

A central venous pressure reading of 11cm/H(2)0 of an IV of normal saline is determined by the nurse caring for the patient. The patient has a diagnosis of pericarditis. Which of the following is the most applicable:

A.

The patient has a condition of hypovolemia.

B.

Not enough fluid has been given to the patient.

C.

Pericarditis may cause pressures greater than 10cm/H(2)0 with testing of CVP.

D.

The patient may have a condition of arteriosclerosis.

A nurse working in a pediatric clinic observes bruises on the body of a four year-old boy. The parents report the boy fell riding his bike. The bruises are located on his posterior chest wall and gluteal region. The nurse should:

A.

Suggest a script for counseling for the family to the doctor on duty.

B.

Recommend a warm bath for the boy to decrease healing time.

C.

Notify the case manager in the clinic about possible child abuse concerns.

D.

Recommend ROM to the patient’s spine to decrease healing time.

A mother that has never breast-feed a child before is having trouble getting the baby to latch on to the breast. The baby has lost 3% of its’ birth weight within the first 2 days of life. The best statement is:

A.

The baby will eventually take to the breast.

B.

I can fix up a bottle if you want to try that.

C.

A small amount of weight loss in the first few days is normal.

D.

I can get the charge nurse to come and talk to you about breast-feeding.

The physician wants to know if a client is tolerating his total parenteral nutrition. Which of the following laboratory tests is likely to be ordered?

A.

triglyceride level

B.

liver function tests

C.

a glucose tolerance test

D.

a complete blood count

Why is it often necessary to draw a complete blood count and differential (CBC/differential) when a client is being treated with an antiepileptic drug (AED)?

A.

The hematocrit is adversely affected because of an increased vascular volume.

B.

AEDs affect immune modulators increasing the risk of infection.

C.

AEDs induce white blood cell reduction.

D.

A side effect of some AEDs is blood dyscrasia.

Tricyclics (Antidepressants) sometimes have which of the following adverse affects on patients that have a diagnosis of depression?

A.

Shortness of breath

B.

Fainting

C.

Large Intestine ulcers

D.

Distal muscular weakness

A gastroenterologist should be consulted for clients suffering from:

A.

digestive system diseases.

B.

urinary system diseases.

C.

female reproductive system diseases.

D.

nervous system diseases.

A nurse reviewed the arterial blood gas reading of a 25 year-old male. The nurse should be able to conclude the patient is experiencing which of the following conditions?

Bicarbonate ion-25 mEq/l

PH-7.41

PaCO2-29 mmHg

PaO2-54 mmHg

(FiO2)-.22

A.

metabolic acidosis

B.

respiratory acidosis

C.

metabolic alkalosis

D.

respiratory alkalosis

A mother brings her 1-year-old child to the clinic. The child has no record of previous immunizations, and the mother confirms the child has not been immunized. Teaching by the nurse should include which of the following?

A.

Immunizations may be started at any age.

B.

The recommended immunization schedule must be followed exactly.

C.

If a primary series of immunizations is interrupted, the series must be restarted.

D.

This child is at increased risk for reaction to the vaccines, when they are started.