NCLEX-PN
NCLEX PN Prep Questions Questions
Extract:
Question 1 of 5
An adult is admitted with Guillain-Barré syndrome. On day 3 of hospitalization, the client's muscle weakness worsens, and he is no longer able to stand with support. He is also having difficulty swallowing and talking. The priority in the nursing care plan at this time is to prevent which problem?
Correct Answer: A
Rationale: Difficulty swallowing increases aspiration risk, making aspiration pneumonia the priority. Other complications are secondary in this acute phase.
Question 2 of 5
The nurse is caring for a child who has had a tonsillectomy. Which of the following are appropriate nursing interventions? Select all that apply.
Correct Answer: A,B,D
Rationale: Ear pain is common post-tonsillectomy due to referred pain, treated with acetaminophen. Bad breath is expected from healing tissue. Frequent swallowing may indicate bleeding, requiring provider notification. Cold liquids are soothing but straws risk trauma. Routine suctioning is unnecessary and risky.
Question 3 of 5
When making a home visit to a client with chronic pyelonephritis, which nursing action has the highest priority?
Correct Answer: C
Rationale: Ask for a log of urinary output. Monitoring urine output is the best indicator of renal function in pyelonephritis.
Question 4 of 5
A nurse receives report on a group of clients. Which client should the nurse assess first?
Correct Answer: B
Rationale: The toddler with circumoral cyanosis, distress, and inability to speak suggests a potential airway obstruction, a life-threatening emergency requiring immediate assessment. Other clients show less acute symptoms.
Question 5 of 5
The nurse is teaching a client about communicable diseases and explains that a portal of entry is:
Correct Answer: D
Rationale: The path by which a microorganism enters the body is the portal of entry. A vector is a carrier of disease, a source (like bad water or food) can be a reservoir of disease.