NCLEX Questions, NCLEX Practice Questions PN Questions, NCLEX-PN Questions, Nurselytic

Questions 176

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Extract:


Question 1 of 5

The clinic nurse is reinforcing teaching to a client about the advance directive form that needs to be completed. Which statement indicates that the client understands the information?

Correct Answer: A

Rationale: Giving a copy to the health care proxy (
A) ensures the advance directive is communicated. Doctor approval (
B), refrigerator posting (
C), and nurse witnessing (
D) are incorrect or unnecessary.

Question 2 of 5

The nurse is caring for a client who had a chest tube inserted and attached to portable water seal drainage two days ago. There is no bubbling in the water seal chamber. What should the nurse assess initially?

Correct Answer: C

Rationale: No bubbling may indicate lung reexpansion or system issues; auscultating lungs assesses reexpansion or complications like pneumothorax. Other assessments are secondary.

Question 3 of 5

The practical nurse is collaborating with the registered nurse to form a care plan for a client with a possible diagnosis of Guillain-Barré syndrome. The nurse should give priority to which client assessment?

Correct Answer: D

Rationale: Respiratory assessment (
D) is the priority in Guillain-Barré syndrome due to the risk of respiratory muscle paralysis. Reflexes (
B) are relevant but less urgent, and blood pressure (
A) and pupils (
C) are not primary concerns.

Question 4 of 5

A man who had a right below-the-knee amputation is placed in the prone position for one hour three times a day. The nurse explains to the man that this is done to prevent which problem?

Correct Answer: C

Rationale: Prone positioning stretches hip flexors, preventing contractures post-amputation. It doesn't primarily address atelectasis, thrombophlebitis, or infection.

Question 5 of 5

A client with borderline personality disorder says to the nurse, 'You're the only one I trust around here. The others don't know what they are doing and they don't care about anyone except themselves. I only want to talk with you.' What is the priority nursing action?

Correct Answer: D

Rationale: Reinforcing boundaries (
D) addresses splitting behavior and maintains therapeutic relationships. Rotating staff (
A), assigning the preferred nurse (
B), or reassuring competence (
C) may reinforce manipulation.

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