NCLEX-PN
NCLEX Trainer Test 1 Questions
Extract:
Question 1 of 5
The nursing assistant reports to the nurse that a client who is one-day postoperative after an angioplasty is refusing to eat and states, 'I just don't feel good.'
Correct Answer: A
Rationale: Assessment is required to determine the cause of the client’s symptoms, as they could indicate complications such as vessel closure, bleeding, hypotension, or dysrhythmias. Talking with the client to assess current symptoms is the most immediate and appropriate action. Encouraging eating, ordering medication, or reviewing past vital signs does not address the need for current assessment.
Question 2 of 5
The home health care nurse is caring for a 30-year-old woman with type I diabetes mellitus.
Correct Answer: B
Rationale: Elevated morning blood glucose levels suggest the dawn phenomenon, where blood sugar rises in the early morning due to hormonal changes. Adding 3 units of NPH insulin at 10 PM addresses this by providing longer-acting insulin coverage. Reducing the diet, adding regular insulin, or eliminating the snack does not target the dawn phenomenon effectively.
Question 3 of 5
An adult male had a myocardial infarction six weeks ago. He asks the nurse if it is safe for him to have sex. What should the nurse include when replying?
Correct Answer: A
Rationale: Nitroglycerin before sexual activity can prevent angina, and sexual activity is generally safe 6 weeks post-MI if the patient is stable.
Question 4 of 5
The nurse is caring for a client with a history of cirrhosis.
Correct Answer: C
Rationale: Asterixis and confusion indicate hepatic encephalopathy, a life-threatening complication of cirrhosis due to ammonia buildup, requiring immediate intervention. Ascites, jaundice, and melena are concerning but less acute.
Question 5 of 5
The nurse is caring for a client who is postoperative day 1 after a gastrectomy. Which of the following findings would be of GREATest concern to the nurse?
Correct Answer: A
Rationale: A temperature of 100.8°F suggests infection, a serious complication post-gastrectomy due to risk of anastomotic leak, requiring immediate evaluation. Options B, C, and D are expected: incision pain, NG tube output, and urine output 40 mL/hour are normal on day 1.