NCLEX Questions, PN NCLEX Practice Exam Questions, NCLEX-PN Questions, Nurselytic

Questions 164

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NCLEX-PN Test Bank

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Extract:


Question 1 of 5

An 86-year-old client with diabetes and gastroparesis has had repeated hospitalizations for aspiration pneumonia following a stroke and is now hospitalized with altered level of consciousness. Which nursing action is most appropriate to decrease the client's risk for developing aspiration pneumonia?

Correct Answer: B

Rationale: The side-lying position (
B) reduces aspiration risk by preventing reflux into the airway, especially in clients with altered consciousness. Assessing breath sounds (
A), oxygen titration (
C), and repositioning (
D) are supportive but less effective for prevention.

Question 2 of 5

A 4-year-old admitted with Wilms tumor is scheduled for a right nephrectomy in the morning. Which nursing action is a priority pre-operatively?

Correct Answer: D

Rationale: Avoiding abdominal palpation (
D) prevents tumor rupture in Wilms tumor, a critical pre-operative priority. Emotional assessment (
A), lung sounds (
B), and BP monitoring (
C) are important but secondary.

Question 3 of 5

While assisting a client with AM care, the nurse notes small elevated skin lesions less than $0.5 \mathrm{cm}$ in diameter over the client's back. The nurse should describe the lesions as:

Correct Answer: D

Rationale: Papules are small, elevated skin lesions less than 0.5 cm in diameter, matching the description provided.

Question 4 of 5

The mother of a 2 year-old hospitalized child asks the nurse's advice about the child's screaming every time the mother gets ready to leave the hospital room. What is the best response by the nurse?

Correct Answer: C

Rationale: Gradually increasing the time of separation can help the child adjust to the mother's absence, reducing anxiety and screaming over time.

Question 5 of 5

The nurse has taught the parents of a 6-year-old client with nephrotic syndrome. Which of the following statements by the parents would require follow-up?

Correct Answer: A

Rationale: Encouraging play with others (
A) may expose the child to infections, risky in nephrotic syndrome due to immunosuppression. Monitoring urine (
B), low-salt diet (
C), and reporting swelling (
D) are correct.

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