Questions 151

NCLEX-RN

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Extract:


Question 1 of 5

A usually reliable interpreter called by the nurse to help communicate with a mother of a child who does not speak English and has brought her child in for a routine visit has yet to arrive in the clinic. The nurse has paged the interpreter several times. Which of the following should the nurse do next?

Correct Answer: B

Rationale: Rescheduling ensures effective communication with the interpreter, avoiding potential misunderstandings during the visit.

Question 2 of 5

The nurse instructs the unlicensed assistive personnel on how to collect a 24-hour urine specimen. Which of the following instructions is correct for a collection that is scheduled to start at 7 a.m. Monday and end at 7 a.m. Tuesday?

Correct Answer: C

Rationale: The 24-hour collection includes all urine from after the 7 a.m. Monday void (discarded) to the 7 a.m. Tuesday void (included).

Question 3 of 5

A client has implemented dietary and other lifestyle changes to manage hypertension. The nurse determines that the client has been most successful when the client has which follow-up blood pressure reading?

Correct Answer: D

Rationale: Normal blood pressure readings are less than 120/80 mm Hg. A blood pressure reading between 120/80 mm Hg and 139/89 mm Hg is considered to be a prehypertensive state. From the readings provided in the options, the correct option identifies the most successful outcome, although the reading indicates a prehypertensive state.

Question 4 of 5

A client with chronic undifferentiated schizophrenia is having an acute exacerbation of symptoms. The client states, 'Black cats and black hats. Where does the time go?' Which of the following would be most important for the nurse to say?

Correct Answer: C

Rationale: Clarifying the client's statement helps assess their thought process and engage therapeutically.

Question 5 of 5

Which tool or scale would you use for a focused neurological assessment of your client?

Correct Answer: D

Rationale: The Rancho Los Amigos Scale is used for assessing levels of consciousness and cognitive recovery in patients with brain injuries, ideal for a focused neurological assessment.

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