NCLEX-PN
NCLEX Trainer Test 3 Questions
Extract:
Question 1 of 5
Assessment findings the nurse could expect to find in the infant with biliary atresia are:
Correct Answer: D
Rationale: Biliary atresia causes bile duct obstruction, leading to clay-colored stools and abdominal distention from liver enlargement, so D is correct. Answers A, B, and C are not specific to biliary atresia.
Extract:
A client who has had an above-knee amputation (AKA) with an immediate prosthetic fitting.
Question 2 of 5
It is MOST important for the nurse to
Correct Answer: D
Rationale: Strategy: Answers are a mix of assessments and implementations. Is there an appropriate assessment? No. Determine the outcome of each implementation. (1) drains not usually used with amputations (2) rigid cast dressing frequently used to create a socket for prosthesis (3) elevation of extremity unnecessary, rigid cast dressing prevents swelling (4) correct-cast applied to provide uniform compression, prevent pain and contractures
Extract:
Question 3 of 5
After the anesthesiologist administers an epidural to a woman in labor, which of the following nursing actions has the HIGHEST priority?
Correct Answer: D
Rationale: Epidural anesthesia can cause hypotension, making blood pressure monitoring the priority to detect complications. Options A, B, and C are secondary or incorrect.
Extract:
During the second session of individual therapy, a client sits quietly with arms folded and eyes cast down.
Question 4 of 5
Which of the following statements by the nurse is BEST?
Correct Answer: D
Rationale: Strategy: 'BEST' indicates that this is a priority question. Remember therapeutic communication. (1) is used to get client comfortable, but would not help to focus on what is important (2) focusing on client's difficulty speaking may make him defensive and block communication (3) concrete questions will encourage client to give yes/no answers, factual answers may block communication of feelings (4) correct-reflection allows client to verbalize feelings
Extract:
Question 5 of 5
The nurse is caring for a newborn with tracheoesophageal fistula. Which nursing diagnosis is a priority?
Correct Answer: B
Rationale: The most common form of TEF is one in which the proximal esophageal segment terminates in a blind pouch and the distal segment is connected to the trachea or primary bronchus by a short fistula. Thus, a priority is maintaining an open airway, preventing aspiration.