NCLEX-PN
NCLEX Trainer Test 1 Questions
Extract:
A client with multiple sclerosis.
Question 1 of 5
The nurse is performing discharge teaching on a client with multiple sclerosis. It is MOST important for the nurse to include which of the following instructions?
Correct Answer: B
Rationale: Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired? (1) client is encouraged to ambulate as tolerated (2) correct-overexposure to heat or cold may cause damage related to the changes in sensation (3) client is encouraged to participate in an exercise program to include ROM, stretching, and strengthening exercises (4) client is encouraged to continue usual activities as much as possible, including social activities
Extract:
Question 2 of 5
Medical records indicate a patient has developed a condition of respiratory alkalosis. Which of the following clinical signs would not apply to a condition of respiratory alkalosis?
Correct Answer: D
Rationale: Anxiety is a clinical sign associated with respiratory acidosis.
Question 3 of 5
A client with a T6 injury 6 months ago develops facial flushing and a BP of 210/106. After elevating the head of the bed, which is the most appropriate nursing action?
Correct Answer: B
Rationale: The symptoms suggest autonomic dysreflexia, often triggered by a distended bladder or bowel in clients with spinal cord injuries above T6. Assessing and addressing the trigger, such as a distended bladder, is the most appropriate action. Notifying the RN may be necessary but is not the immediate action, so answer A is incorrect. Oxygen and increased IV fluids do not address the cause, so answers C and D are incorrect.
Question 4 of 5
While explaining an illness to a 10 year-old, what should the nurse keep in mind about the cognitive development at this age?
Correct Answer: B
Rationale: They are able to think logically in organizing facts. The child in the concrete operations stage is capable of mature thought when organizing objects.
Question 5 of 5
A nurse arranges for a interpreter to facilitate communication between the health care team and a non-English speaking client. To promote therapeutic communication, the appropriate action for the nurse to remember when working with an interpreter is to
Correct Answer: A
Rationale: The nurse should communicate with the client and the family, not with the interpreter. Culturally appropriate eye contact, gestures, and body language toward the client and family are important factors to enhance rapport and understanding. Maintain eye contact with both the client and interpreter to elicit feedback and read nonverbal cues.