NCLEX Questions, NCLEX RN Practice Questions Questions, NCLEX-RN Questions, Nurselytic

Questions 149

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Extract:


Question 1 of 5

The client who is 2 weeks post-burn with a 40% deep partial-thickness injury still has open wounds. The nurse's assessment reveals the following findings: temperature 96.5°F, BP 87/40, and severe diarrhea stools. What problem does the nurse most likely suspect?

Correct Answer: C

Rationale: Hypothermia, hypotension, and diarrhea suggest systemic gram-negative infection, likely sepsis, due to bacterial translocation from open wounds or the gut in a burn patient.

Question 2 of 5

The nurse is working on a postsurgical floor with an LPN. A new client has just arrived. Which task is appropriate for the nurse to delegate to the LPN?

Correct Answer: A

Rationale: Taking vital signs is within an LPN’s scope. PICC line flushing, IV morphine, and TPN initiation require RN-level judgment.

Question 3 of 5

An adolescent client is seen by the nurse at a school where a fatal shooting incident occurred on campus 3 months earlier. The nurse documents that the client is experiencing flashbacks, avoiding the location of the shooting, having angry outbursts, and experiencing a loss of interest in playing his favorite musical instrument. The nurse suspects the client is experiencing post-traumatic stress disorder. Which intervention would be the best for the nurse to implement?

Correct Answer: B

Rationale: Referring to the multidisciplinary crisis team ensures comprehensive, coordinated care for suspected PTSD, leveraging expertise beyond the nurse’s scope.

Question 4 of 5

The nurse is caring for a 10-year-old client who states, 'I am really good at soccer because I practice every day.' According to Erikson's eight stages of development, which psychosocial crisis does this statement reflect?

Correct Answer: B

Rationale: A 10-year-old’s pride in skill development reflects industry vs. inferiority, typical of school-age children striving for competence.

Question 5 of 5

The nurse is teaching a new breastfeeding mother about breast care, but the mother has engorgement and asks if she should quit breastfeeding. Which information should the nurse include? Select all that apply.

Correct Answer: A,B,D,E

Rationale: Continue nursing (
A), massaging breasts (
B), using pain relievers (
D), and noting engorgement resolution in 24-48 hours (E) manage engorgement. Hot compresses (
C) may worsen swelling.

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