NCLEX-PN
NCLEX Trainer Test 8 Questions
Extract:
Question 1 of 5
A client is in the third month of her first pregnancy. During the interview, she tells the nurse that she has several sex partners and is unsure of the identity of the baby's father. Which of the following nursing interventions is a priority?
Correct Answer: A
Rationale: Counsel the woman to consent to HIV screening. The client's behavior places her at high risk for HIV. Testing is the first step to ensure early treatment if positive.
Question 2 of 5
Which of these clients would the nurse monitor for the complication of C. difficile diarrhea?
Correct Answer: D
Rationale: A middle-aged client receiving radiation for throat cancer. Radiation therapy, particularly to the abdomen or pelvis, can disrupt the gut microbiota and increase the risk of C. difficile infection, especially if the client is also receiving antibiotics or has a weakened immune system.
Extract:
A 12-year-old girl whose tracheostomy tube inserted 2 days ago has been accidentally dislodged.
Question 3 of 5
The nurse should
Correct Answer: A
Rationale: Strategy: Answers are a mix of assessments and implementations. Does this situation require validation? No. Determine the outcome of the implementations. Remember ABCs. (1) correct-implementation, will secure the airway (2) implementation, will not provide for open airway (3) implementation, will not help with open airway (4) assessment, should be done after tracheostomy tube is replaced
Extract:
A client receiving amphotericin B (Fungizone) 1 mg in 250 cc of 5% dextrose in water IV over a 2-hour period.
Question 4 of 5
The nurse should be MOST concerned if which of the following was observed?
Correct Answer: B
Rationale: Strategy: 'MOST concerned' indicates an untoward effect of the medication. (1) normal results, causes renal toxicity, BUN and creatine would be elevated, normal BUN 7-18 mg/dL, normal creatine 0.6-1.2 mg/dL (2) correct-monitor vital signs every 30 min (3) not side effect of medication (4) normal AST (formerly SGOT) 8-20 U/L, normal ALT (formerly SGPT) 8-20 U/L, normal bilirubin 0.1-1.0 mg/dL, may cause elevation, check liver function studies weekly, notify physician if elevated
Extract:
The triage nurse for a women's health center receives a phone call from each of the following women.
Question 5 of 5
Which woman should be directed to come to the health care facility IMMEDIATELY?
Correct Answer: A
Rationale: Strategy: Determine the least stable client. (1) correct-needs to be evaluated for an ectopic pregnancy (2) expect during first trimester of pregnancy (3) symptomatic of threatened abortion; instruct to decrease activity (4) symptoms of spontaneous abortion; instruct client to save and count pads