NCLEX-PN
NCLEX Trainer Test 6 Questions
Extract:
Question 1 of 5
The nurse is caring for a client with cirrhosis of the liver with ascites. When instructing nursing assistants in the care of the client, the nurse should emphasize that the client
Correct Answer: B
Rationale: Should alternate ambulation with bed rest with legs elevated. Encourage alternating periods of ambulation and bed rest with legs elevated to mobilize edema and ascites.
Question 2 of 5
When caring for an abused client, what is most important for the nurse to do initially?
Correct Answer: A
Rationale: Providing a safe place is the priority, ensuring immediate protection from further abuse before addressing long-term support.
Question 3 of 5
Upon completing the admission documents, the nurse learns that the 87 year-old client does not have an advance directive. What action should the nurse take?
Correct Answer: B
Rationale: For each admission, nurses should request a copy of the current advance directive. If there is none, the nurse must offer information about what an advance directive implies. It is then the client's choice to sign it.
Question 4 of 5
A client in the intensive care unit is overheard telling his wife, 'It's impossible to get any sleep in this place with all the noise and lights on all the time.' After talking with the client, the nurse determines that the client is bothered by sensory disturbance related to being in the ICU. Which laboratory finding would confirm the nurse's assessment of sensory disturbance?
Correct Answer: A
Rationale: Sensory disturbance and stress in the ICU increase catecholamines (e.g., epinephrine), detectable in urine. Other labs are unrelated to sensory disturbance.
Question 5 of 5
The nurse is planning care for a 2 year-old hospitalized child. Which of the following will produces the most stress at this age?
Correct Answer: A
Rationale: Separation anxiety. While a toddler will experience all of the stresses, separation from parents is the major stressor.