NCLEX Questions, NCLEX-PN Practice Questions Quizlet Questions, NCLEX-PN Questions, Nurselytic

Questions 227

NCLEX-PN

NCLEX-PN Test Bank

NCLEX-PN Practice Questions Quizlet Questions

Extract:


Question 1 of 5

The nurse is caring for clients on a medical/surgical unit and determines that several situations need to be addressed. Which of the following situations should the nurse attend to FIRST?

Correct Answer: D

Rationale: A nosebleed post-radiation therapy is the least stable situation, as it may indicate a serious complication like tissue damage or coagulopathy, requiring immediate assessment. The daughter’s threat (
A) is administrative, the overdue assistant (
B) is a personnel issue, and the physician’s request (
C) can be delegated, all of which are lower priority.

Question 2 of 5

Which of the following statements, if made by the parents of a newborn, does not indicate a need for further teaching about cord care?

Correct Answer: D

Rationale: Washing hands before and after cord care prevents infection and is correct. The other statements reflect outdated or incorrect practices (e.g., alcohol is no longer recommended, and the cord should be kept exposed). Health Promotion and Maintenance

Question 3 of 5

The nurse is performing an assessment on a client who is cachectic and has developed an enterocutaneous fistula following surgery to relieve a small bowel obstruction. The client's total protein level is reported as 4.5 g/dl. Which of the following would the nurse anticipate?

Correct Answer: C

Rationale: The client is not absorbing nutrients adequately as evidenced by the cachexia and low protein levels. (A normal total serum protein level is 6.0-8.0 g/dl.) TPN will promote a positive nitrogen balance in this client who is unable to digest and absorb nutrients adequately.

Question 4 of 5

The nurse is caring for a client with a deep vein thrombosis (DVT) who is receiving heparin therapy. Which of the following laboratory values should the nurse monitor closely?

Correct Answer: B

Rationale: Heparin’s anticoagulant effect is monitored via aPTT, with a therapeutic range of 1.5–2.5 times the control value to ensure effective DVT treatment without bleeding risk. PT/INR (A,
C) monitor warfarin, and platelet count (
D) is monitored for heparin-induced thrombocytopenia but is secondary.

Extract:

In caring for a patient with ALS (Amyotrophic Lateral Sclerosis)


Question 5 of 5

In caring for a patient with ALS (Amyotrophic Lateral Sclerosis), the nursing diagnosis with the HIGHEST priority would be:

Correct Answer: C

Rationale: Ineffective airway clearance is the highest priority due to risk of respiratory failure in ALS.

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