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

Questions 164

NCLEX-PN

NCLEX-PN Test Bank

NCLEX PN Practice Tests Questions

Extract:


Question 1 of 5

The nurse is caring for a client who had a total abdominal hysterectomy 2 days ago. The client reports hearing music coming from the television, which is turned off. Which of the following actions should the nurse take first?

Correct Answer: B

Rationale: Checking the medication record identifies potential causes of hallucinations, such as opioids or anesthetics. Timing, vital signs, and TV checks are secondary to ruling out medication effects.

Extract:

Laboratory reference ranges
INR
0.8-1.1


Question 2 of 5

The nurse receives report on 4 clients. Which of the following clients should the nurse see first?

Correct Answer: A

Rationale: Discomfort at an IV vancomycin site suggests possible infiltration or phlebitis, requiring immediate assessment to prevent tissue damage. INR of 1.9 is subtherapeutic but less urgent, itching/nausea are expected morphine side effects, and tubing changed 48 hours ago is within standard protocol.

Extract:


Question 3 of 5

The nurse is teaching the client the appropriate way to use a metered dose inhaler. Which observation indicates the client needs additional teaching?

Correct Answer: C

Rationale: When using a metered dose inhaler, the client should wait 1-2 minutes between puffs to ensure proper absorption, not 30 seconds. Answer C indicates a need for additional teaching. Answers A, B, and D describe correct techniques for inhaler use.

Question 4 of 5

The nurse in the long-term care facility discovers a client with dementia wandering in the hallway during the night. Which of the following statements would be most appropriate for the nurse to make?

Correct Answer: C

Rationale: Orienting the client and gently redirecting them to their room is calming and safe. Questioning, warning, or instructing may confuse or agitate a client with dementia.

Question 5 of 5

The nurse is caring for a client who had thoracic surgery yesterday and has a chest tube attached to water seal drainage. The client's family asks why he has to have a chest tube. What should the nurse include in the response?

Correct Answer: B

Rationale: Chest tubes remove air/fluid from the pleural cavity, allowing lung reexpansion post-thoracic surgery. Other options misrepresent the tube's function.

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