NCLEX-PN
NCLEX Trainer Test 5 Questions
Extract:
Question 1 of 5
The nurse is teaching a client with a new diagnosis of gout about colchicine. Which of the following instructions should the nurse include?
Correct Answer: B
Rationale: Diarrhea is a serious colchicine side effect, indicating potential toxicity. Options A, C, and D are incorrect.
Extract:
A client with a marked depression of T cells.
Question 2 of 5
To promote safety in the environment of a client with a marked depression of T cells, the nurse should
Correct Answer: D
Rationale: Strategy: Answers are implementations. Determine the outcome of each answer choice. Is it desired? (1) protocol for handling soiled articles is accomplished within universal guidelines with double biohazard bags (2) universal precautions and client protection may call for plastic utensils, but not just spoons (3) not protocol unless the client has an active pulmonary infection (4) correct-water should not be allowed to stand in containers, such as respiratory or suction equipment, because this could act as a culture medium
Extract:
Question 3 of 5
The nurse is caring for a client following removal of the thyroid. Immediately post-op the nurse should:
Correct Answer: A
Rationale: Semi-Fowler's position reduces swelling and supports the surgical site post-thyroidectomy. Turning the head or flexing the neck risks wound dehiscence. Supine with sandbags is unnecessary and uncomfortable.
Extract:
A client with a new tracheotomy with a small amount of serosanguineous drainage on the dressing. A client who is responsive with a moderate amount of clear fluid draining from the NG tube. A client with a chest tube and dark red drainage in the collection chamber. A client who is unresponsive to verbal stimuli with the oral airway out of place.
Question 4 of 5
The nurse is caring for clients in the postanesthesia care unit (PACU). Which of the following clients require IMMEDIATE attention by the nurse?
Correct Answer: D
Rationale: Strategy: Remember the ABCs. (1) expected outcome, patient is stable (2) no indication of complications, stable client (3) expected outcome, gently 'milk' tubing in the direction of the drainage, if needed (4) correct-reinsert airway to maintain patent airway
Extract:
A client has returned to the floor from thyroidectomy surgery.
Question 5 of 5
After a client has returned to the floor from thyroidectomy surgery, it is MOST important for the nurse to take which of the following actions?
Correct Answer: C
Rationale: Strategy: Answers are a mix of assessments and implementations. Does this situation require assessment? Yes. Determine what assessment is being made in each answer choice. (1) assessment is not specific to this surgery (2) assessment, method used to monitor for postoperative hemorrhage in a tonsillectomy client (3) correct-assessment, after surgery, swelling can occur, which causes respiratory distress (4) implementation, head of the bed should be elevated