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Questions 160

NCLEX-PN

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Question 1 of 5

When changing a sterile abdominal dressing, which nursing actions would violate the principles of asepsis? Select all that apply.

Correct Answer: D,E,F

Rationale: Cleaning from the outer edge toward the center introduces contaminants to the wound, violating asepsis. Reaching across the sterile field and touching the soiled dressing with sterile gloves contaminate the sterile field and gloves, respectively.

Question 2 of 5

A 75-year-old client has a perineal prostatectomy for prostate cancer. Which nursing action is essential to include in the client's care plan?

Correct Answer: D

Rationale: Perineal care after bowel movements prevents infection at the surgical site, a critical post-prostatectomy action.

Question 3 of 5

What is the best evidence that a postpartum client's Kegel exercises are effective?

Correct Answer: D

Rationale: Effective Kegel exercises strengthen pelvic floor muscles, allowing the client to control urine flow, indicating success.

Question 4 of 5

A client with a history of pancreatitis reports severe abdominal pain. Which position should the nurse encourage?

Correct Answer: B

Rationale: Side-lying with knees flexed reduces tension on the pancreas, alleviating pain.

Question 5 of 5

After a 6-year-old child undergoes a tonsillectomy, the nurse instructs the parents to avoid giving the child aspirin or aspirin products. What is the best explanation for the nurse's instruction?

Correct Answer: B

Rationale: Aspirin is linked to Reye's syndrome in children, a rare but serious condition, especially post-viral infections.

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