NCLEX-PN
NCLEX Trainer Test 5 Questions
Extract:
Question 1 of 5
A client admitted to the psychiatric unit claims to be the 'Son of God' and insists that he will not be confined by 'mere mortals.' The most likely explanation for the client's delusions is:
Correct Answer: C
Rationale: Delusions of grandeur, like claiming to be the 'Son of God,' often stem from low self-esteem, compensating with inflated self-perception. Religious conversion, stress, or anxiety are less likely causes.
Question 2 of 5
An adult who has chronic obstructive pulmonary disease (COPD) is receiving oxygen at home via nasal cannula. In addition to instructing the client and his family about not smoking when oxygen is in use, what should the nurse plan to include in the teaching?
Correct Answer: B
Rationale: Shuffling across carpet generates static electricity, risking sparks near oxygen, which is a fire hazard. Adjusting oxygen flow without medical orders or cleaning with alcohol (instead of soap and water) is unsafe.
Question 3 of 5
An adult who has myasthenia gravis is about to be discharged. Neostigmine is prescribed for her. What should the nurse include when teaching the client about this drug? Tell the client to take the drug:
Correct Answer: A
Rationale: Taking neostigmine 30 minutes before meals maximizes muscle strength for chewing and swallowing, critical for myasthenia gravis patients, unlike other timing.
Question 4 of 5
A 3-year-old with coarctation of the aorta is scheduled for corrective surgery. Which preoperative lab result should be reported to the physician?
Correct Answer: B
Rationale: A WBC of 14,000 suggests possible infection, which should be reported before surgery, so B is correct. HCT 48% , platelet count 200,000 , and RBC 5.3 are within normal ranges.
Extract:
A client who is receiving hydralazine (Apresoline) q6h has a blood pressure of 90/60.
Question 5 of 5
Which of the following nursing actions would be MOST appropriate?
Correct Answer: A
Rationale: Strategy: Answers are a mix of assessments and implementations. Is there an appropriate assessment? No. Determine the outcome of the implementations. (1) correct-BP of 90/60 is too low for an additional dose of medication, withholding the medication and checking with the doctor is appropriate (2) assessment, appropriate nursing action for a client on an antihypertensive that has diuretic effects due to increased blood flow to the kidney, not a priority in this instance (3) unnecessary (4) appropriate nursing action for a client on an antihypertensive that has diuretic effects due to increased blood flow to the kidney, not a priority in this instance