NCLEX-PN
NCLEX Trainer Test 7 Questions
Extract:
Question 1 of 5
The nurse observes a staff member caring for a client with a left unilateral mastectomy. The nurse would intervene if she notices the staff member is
Correct Answer: B
Rationale: Taking the blood pressure in the left arm. Clients who have had a unilateral mastectomy should not have their blood pressure measured on the affected side. This helps avoid the possibility of lymphedema post-operatively and in the future.
Question 2 of 5
The nurse is working with parents to plan home care for a 2 year-old with a heart problem. A priority nursing intervention would be to
Correct Answer: A
Rationale: Encourage the parents to enroll in cardiopulmonary resuscitation (CPR) class. While all suggestions are appropriate, the education of the parents/caregivers should include techniques of cardiopulmonary resuscitation in order to provide for emergency care of their child.
Question 3 of 5
The nurse is caring for all of the following clients. Who is probably at greatest risk for skin breakdown and will need special nursing care measures?
Correct Answer: A
Rationale: A broken hip limits mobility, increasing pressure ulcer risk due to prolonged immobility, requiring special skin care measures.
Question 4 of 5
A 28-year-old primigravida with pregestational diabetes visits the clinic 6 weeks gestation. Which of the following statements indicates that she understands the nurse's teaching regarding her insulin needs during pregnancy?
Correct Answer: B
Rationale: Pregnancy hormones increase insulin resistance, requiring more insulin as pregnancy progresses in diabetic patients. Other statements are incorrect regarding insulin dynamics.
Question 5 of 5
The nurse is teaching family members how to correctly transfer a client who has right hemiplegia from the bed to a wheelchair. Which observation indicates that the family understands how to transfer the client?
Correct Answer: C
Rationale: Placing the wheelchair at a 45-degree angle on the unaffected side allows the client to pivot using their stronger left side, ensuring a safe transfer. Affected-side placement or neck lifting is unsafe, and a trapeze is unnecessary.