NCLEX-PN
NCLEX Trainer Test 1 Questions
Extract:
Question 1 of 5
The nurse is caring for a client with a history of type 1 diabetes who is receiving insulin lispro (Humalog) 8 units subcutaneously before meals. Which of the following findings would be of GREATest concern to the nurse?
Correct Answer: C
Rationale: Sweating and confusion indicate hypoglycemia, a serious complication of insulin lispro, requiring immediate treatment with carbohydrates. Options A, B, and D are normal: glucose 90 mg/dL, heart rate 80 bpm, and blood pressure 120/80 mmHg indicate stability.
Question 2 of 5
The nurse has received her assignment for the day and is to care for the following clients. Which client should the nurse go to first?
Correct Answer: A
Rationale: The client with recent hematemesis is at risk for recurrent bleeding, requiring immediate assessment to ensure stability, prioritizing over stable surgical or presurgical clients.
Question 3 of 5
A client returned from surgery for a perforated appendix with localized peritonitis. In view of this diagnosis, how would the nurse position the client?
Correct Answer: C
Rationale: Semi-Fowler. The semi-Fowler position assists drainage and prevents spread of infection throughout the abdominal cavity.
Question 4 of 5
Which of the following infants is in need of additional growth assessment?
Correct Answer: B
Rationale: Baby B has gained only 1 oz. in 2 weeks, indicating poor growth (normal is 0.5-1 oz./day). Others show appropriate weight gain.
Question 5 of 5
The home health care nurse is caring for a 30-year-old woman with type I diabetes mellitus.
Correct Answer: B
Rationale: Elevated morning blood glucose levels suggest the dawn phenomenon, where blood sugar rises in the early morning due to hormonal changes. Adding 3 units of NPH insulin at 10 PM addresses this by providing longer-acting insulin coverage. Reducing the diet, adding regular insulin, or eliminating the snack does not target the dawn phenomenon effectively.