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Questions 227

NCLEX-PN

NCLEX-PN Test Bank

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Extract:


Question 1 of 5

The nurse on the psychiatric unit is caring for several clients. Which client needs the most immediate attention?

Correct Answer: C

Rationale: Screaming and running indicate potential danger to self or others, requiring immediate intervention to ensure safety.

Question 2 of 5

A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy. Which of the following oxygen delivery devices is most appropriate for this patient?

Correct Answer: C

Rationale: The Venturi mask delivers precise oxygen concentrations, critical for COPD patients to avoid CO2 retention. Nasal cannulas are less precise, and non-rebreather or simple masks deliver high oxygen inappropriately.

Question 3 of 5

An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:

Correct Answer: B

Rationale:
To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If necessary, this treatment can be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.

Question 4 of 5

Clients with mitral stenosis would likely manifest findings associated with congestion in the

Correct Answer: A

Rationale: Pulmonary circulation. Inefficient emptying of the left ventricle causes back-flow into the pulmonary vein, leading to congestion.

Extract:

A mother with cystic fibrosis child is receiving health teaching from the nurse regarding danger signs of her illness.


Question 5 of 5

The mother has best understood the teaching when she says:

Correct Answer: C

Rationale: Respiratory distress, indicated by tiredness, is a critical danger sign in cystic fibrosis.

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