NCLEX-PN
NCLEX Trainer Test 2 Questions
Extract:
Question 1 of 5
The newborn infant of an HIV-positive mother is admitted to the nursery.
Correct Answer: A
Rationale: Standard precautions are the immediate priority to protect staff and others from potential HIV transmission. HIV Test ing and AZT may be considered later, and transfer is unnecessary without clinical indication.
Question 2 of 5
A client tells the nurse he is fearful of planned surgery because of evil thoughts about a family member. What is the best initial response by the nurse?
Correct Answer: D
Rationale: Listen to the client. Therapeutic communications are based on attentive listening to expressed feelings, followed by questions about cultural beliefs if needed.
Question 3 of 5
The nurse is assessing the mental status of a client admitted with possible organic brain disorder. Which of these questions will best assess the functioning of the client's recent memory?
Correct Answer: C
Rationale: I am going to say the names of three things and I want you to repeat them after me: blue, ball, pen. This tests immediate recall, a component of recent memory.
Question 4 of 5
The nurse is caring for a client with a pressure ulcer.
Correct Answer: A
Rationale: A hydrocolloid dressing maintains a moist environment, promoting healing in a stage III pressure ulcer. Hydrogen peroxide is cytotoxic, repositioning every 2 hours is standard, and antibiotics are only used for infection.
Question 5 of 5
The nurse is administering terbutaline (Brethine) to a client in labor.
Correct Answer: A
Rationale: Terbutaline causes maternal tachycardia, and a pulse of 144 indicates a significant side effect. Withholding the medication is the priority to prevent further complications like pulmonary edema. Reducing the dose, administering, or delaying without action is unsafe.