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

Questions 157

NCLEX-PN

NCLEX-PN Test Bank

ATI NCLEX-PN Practice Questions Questions

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Question 1 of 5

The home health nurse is assessing a client diagnosed with congestive heart failure who has a slice of raw potato on a carbuncle on the abdomen. Which action should the nurse implement first?

Correct Answer: B

Rationale: Asking about the potato’s purpose respects cultural or folk beliefs (e.g., drawing out infection) and guides care. Explaining, cleansing, or ignoring may dismiss the client’s perspective.

Question 2 of 5

According to the nursing process, which interventions should the nurse implement when caring for a client diagnosed with a right-sided cerebrovascular accident (stroke) and who has difficulty swallowing? List the interventions in order of the nursing process.

Order the Items

Source Container

Write the client problem of 'altered tissue perfusion.'
Assess the client's level of consciousness and speech.
Request dietary to send a full liquid tray with Thick-It.
Instruct the UAP to elevate the head of the bed 30 degrees.
Note the amount of food consumed on the dinner tray.

Correct Answer: B,A,C,D,E

Rationale: 1) Assess LOC/speech (assessment); 2) Write problem (diagnosis); 3) Request diet (planning); 4) Instruct HOB elevation (implementation); 5) Note food intake (evaluation).

Question 3 of 5

The client diagnosed with stomach cancer has developed disseminated intravascular coagulopathy (DIC). Which collaborative intervention should the nurse expect to implement?

Correct Answer: A

Rationale: Heparin prevents further clotting in DIC, a standard collaborative intervention, per ISTH guidelines.

Question 4 of 5

The client comes to the clinic complaining of itching on the left wrist near a wristwatch. The nurse notes an erythematous area along with pruritic vesicles around the left wrist. Which condition should the nurse suspect?

Correct Answer: A

Rationale: Itching, erythema, and vesicles near a wristwatch suggest contact dermatitis, likely from nickel allergy.

Question 5 of 5

The unlicensed assistive personnel (UAP) notifies the nurse the client diagnosed with chronic obstructive pulmonary disease is complaining of shortness of breath and would like his oxygen level increased. Which intervention should the nurse implement?

Correct Answer: C

Rationale: A pulse oximeter reading assesses oxygenation status, guiding whether oxygen adjustment is needed.

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