NCLEX-PN
NCLEX PN Prep Questions Questions
Extract:
Question 1 of 5
The nurse is caring for a child who has had a tonsillectomy. Which of the following are appropriate nursing interventions? Select all that apply.
Correct Answer: A,B,D
Rationale: Ear pain is common post-tonsillectomy due to referred pain, treated with acetaminophen. Bad breath is expected from healing tissue. Frequent swallowing may indicate bleeding, requiring provider notification. Cold liquids are soothing but straws risk trauma. Routine suctioning is unnecessary and risky.
Question 2 of 5
Which nursing diagnosis is least likely to apply to the client admitted with a diagnosis of borderline personality disorder?
Correct Answer: D
Rationale: Borderline personality disorder is characterized by self-injury, identity issues, and low self-esteem, making A, B, and C relevant. Sensory-perceptual alteration is more associated with psychotic disorders, so D is least likely.
Question 3 of 5
When making a home visit to a client with chronic pyelonephritis, which nursing action has the highest priority?
Correct Answer: C
Rationale: Ask for a log of urinary output. Monitoring urine output is the best indicator of renal function in pyelonephritis.
Question 4 of 5
The nurse is caring for a client who will not use the train for transportation due to the fear of being trapped and unable to escape. The nurse should recognize that the client is likely experiencing
Correct Answer: C
Rationale: Fear of being trapped in situations (e.g., trains) with no escape is characteristic of agoraphobia. Generalized anxiety involves broad worries, social anxiety focuses on social scrutiny, and acrophobia is fear of heights.
Question 5 of 5
A client with ascites due to cirrhosis has increasing shortness of breath and abdominal pain and is scheduled for paracentesis. Which of the following nursing actions should be implemented prior to the procedure? Select all that apply.
Correct Answer: A,D,E
Rationale: Informed consent ensures understanding, emptying the bladder prevents injury during needle insertion, and baseline vital signs/weight monitor fluid shifts. Reverse Trendelenburg is inappropriate; upright positioning is typical. NPO status isn't required for paracentesis.