NCLEX-PN
NCLEX Trainer Test 2 Questions
Extract:
Question 1 of 5
An adult male calls his nurse neighbor and says he is having severe chest pain and feels as though something terrible is happening to him. He rates his pain as 10 on the 10-point scale. In addition to calling 911, what should the nurse recommend the man do now?
Correct Answer: A
Rationale: Aspirin reduces clot formation in suspected myocardial infarction, improving outcomes, and should be taken immediately.
Question 2 of 5
Following a coronary artery bypass, a client develops a temperature of 102°. The nurse should notify the doctor because an elevation in temperature:
Correct Answer: B
Rationale: A fever increases metabolic demand, which can decrease cardiac output in a post-bypass patient, potentially straining the heart.
Extract:
A client receiving oxygen at 6 L/min.
Question 3 of 5
What information concerning the patient is MOST important for the nurse to document on the lab slip that accompanies the blood sample?
Correct Answer: C
Rationale: Strategy: Think about each answer choice and how it relates to blood gases. (1) unnecessary to document positioning (2) unnecessary to document site used (3) correct-necessary for accurate Test results (4) unnecessary to document blood type, should document diagnosis
Extract:
Question 4 of 5
At 10:00 A.M., the nurse discovers a 75-year-old woman who is hospitalized with congestive heart failure on the floor beside the bed. She has a bruise on her leg, but x-rays reveal no fractures. How should the nurse record the incident in the client's chart?
Correct Answer: B
Rationale: Accurate documentation includes specific details: time, client status, mechanism of fall, assessment findings (bruise size, orientation), and actions taken (physician notification, x-rays). This option is thorough and objective, unlike the others, which are vague or incomplete.
Question 5 of 5
The nurse is caring for a client with a new colostomy. Which of the following client statements indicates a need for further teaching?
Correct Answer: B
Rationale: Emptying the pouch every morning is a rigid schedule that does not account for individual bowel patterns; it should be emptied when one-third to one-half full. Options A, C, and D are correct: changing when one-third full prevents leaks, high-fiber diets promote regularity, and skin checks prevent breakdown.