NCLEX-PN
NCLEX Trainer Test 4 Questions
Extract:
Question 1 of 5
The nurse is evaluating the progress of a client who has had a cerebrovascular accident and realizes there has been limited progress. What should the nurse do?
Correct Answer: B
Rationale: Reassessing goals adjusts the care plan to the client's current abilities, optimizing recovery post-CVA.
Question 2 of 5
The nurse is providing home care to a confused older adult. The family members have tied the client in a chair with a large leather belt. They say the client wanders if he isn't restrained. What initial nursing action is most appropriate?
Correct Answer: C
Rationale: Helping the family create a safer environment addresses wandering non-restrictively, promoting safety and autonomy. Reporting, praising, or prohibiting are less constructive.
Question 3 of 5
A clear liquid diet is ordered for an adult following surgery. All of the following are on the client's tray. Which should be removed by the nurse?
Correct Answer: A
Rationale: Ice cream is not a clear liquid, as it contains dairy solids, and must be removed from a clear liquid diet tray.
Question 4 of 5
In evaluating the growth of a 12 month-old child, which of these findings would the nurse expect to be present in the infant?
Correct Answer: C
Rationale: Tripled the birth weight. Infants typically triple their birth weight by 12 months.
Question 5 of 5
The nurse is caring for a client with a history of glaucoma.
Correct Answer: A
Rationale: Applying pressure to the inner canthus (nasolacrimal occlusion) prevents systemic absorption of timolol, reducing side effects like bradycardia. Drops are used regularly, not symptom-based, and cleansing is unnecessary unless debris is present.