NCLEX-PN
NCLEX-PN Free Practice Questions Questions
Extract:
Question 1 of 5
Post-procedure nursing interventions for electroconvulsive therapy include
Correct Answer: C
Rationale: Remaining with client until oriented. The client is groggy and confused post-procedure, requiring close monitoring until fully oriented.
Question 2 of 5
The nurse is supervising the staff providing care for an 18-month-old hospitalized with hepatitis A. The nurse determines that the staff's care is appropriate if which of the following is observed?
Correct Answer: A
Rationale: Hepatitis A requires contact precautions for diapered patients due to fecal-oral transmission, necessitating a private room. Removing toys (
B) risks spreading contamination, a high-fat diet (
C) is inappropriate, and standard precautions alone (
D) are insufficient.
Question 3 of 5
The nurse is preparing to boost a client up in bed. She instructs the client to use the overbed trapeze. Which risk factor for pressure ulcer development is the nurse reducing by instructing the client to move in this manner?
Correct Answer: D
Rationale: Using a trapeze reduces shearing forces (opposing forces that cause layers of skin to move over each other, stretching and tearing capillaries and, eventually, resulting in necrosis), which increase the risk of pressure ulcer development. They can occur as clients slide down in bed or when they're pulled up in bed.
To reduce shearing forces, the nurse should instruct the client to use an overbed trapeze, place a draw sheet under the client to move the client up in bed, and keep the head of the bed no higher than 30 degrees. The risks of friction, impaired circulation, and localized pressure aren't decreased with trapeze use.
Question 4 of 5
The nurse is caring for an older client who insists on having a 'hot toddy' laced with liquor at bedtime to help her sleep. How should the nurse respond in order to give culturally sensitive and appropriate care?
Correct Answer: A
Rationale: Exploring the cultural or personal significance of the hot toddy shows respect, fostering culturally sensitive care.
Question 5 of 5
The nurse is supervising an unlicensed person who is giving oral care to an unconscious client. Which observation indicates that the unlicensed person needs further instruction?
Correct Answer: B
Rationale: An upright position risks aspiration in an unconscious client; lateral positioning with head turned prevents this, indicating a need for instruction.