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

Questions 164

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Extract:


Question 1 of 5

The home health nurse is providing long-term care to several clients. Which are examples of inappropriately crossing professional boundaries? Select all that apply.

Correct Answer: A,D,E

Rationale: Accepting expensive gifts (
A), soliciting investments (
D), and socializing with alcohol (E) violate professional boundaries. Offering to pray (
B) is acceptable if client-initiated, and a sympathy card (
C) is appropriate.

Question 2 of 5

A client is admitted for removal of a goiter. Which nursing intervention should receive priority during the post-operative period?

Correct Answer: B

Rationale: A goiter is hyperplasia of the thyroid gland. Removal of a goiter can result in laryngeal spasms and airway occlusion. The other answers are lesser in priority.

Question 3 of 5

A nurse is caring for an elderly client who had a colectomy for removal of cancer 2 days ago. The client is becoming increasingly restless and has been given IV morphine every 2 hours for severe pain. Respirations are 28/min and shallow. Which arterial blood gas results best indicate that the client is in acute respiratory failure and needs immediate intervention?

Correct Answer: A

Rationale: PaO2 < 50 mm Hg and PaCO2 > 50 mm Hg (
A) indicate acute respiratory failure, requiring immediate intervention. Other options show less severe hypoxemia or normal values.

Question 4 of 5

When writing in the client's chart, the nurse makes an error in documentation. The nurse should:

Correct Answer: D

Rationale: Drawing a single line through the error and initialing maintains transparency and legality. Erasing, blackening, or rewriting the sheet is improper.

Question 5 of 5

Which nursing diagnosis is most appropriate for a client who has Cushing's syndrome?

Correct Answer: A

Rationale: Cushing's syndrome causes cortisol excess, leading to osteoporosis and increased fracture risk, making 'Risk for injury related to osteoporosis' the most appropriate diagnosis.

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