NCLEX Questions, NCLEX PN Practice Test Questions, NCLEX-PN Questions, Nurselytic

Questions 164

NCLEX-PN

NCLEX-PN Test Bank

NCLEX PN Practice Test Questions

Extract:


Question 1 of 5

Which of the following indicates that the client taking an anticoagulant needs further teaching?

Correct Answer: B

Rationale: Green, leafy vegetables are high in vitamin K, which can counteract anticoagulants like warfarin, so consistent intake or dietary counseling is needed.

Question 2 of 5

A young adult is admitted with a possible head injury. The car in which he was riding hit a utility pole, and the client's head hit the windshield. Baseline vital signs are BP=112/74, P=80, and R=12. The nurse checks the client an hour after admission. Which finding(s) are significant and should be reported to the charge nurse or physician immediately? Select all that apply.

Correct Answer: C,D

Rationale: Slow respirations (8) and projectile vomiting suggest increased intracranial pressure, critical in head injury, requiring immediate reporting. BP, pulse, skin, and pupil response changes are less urgent.

Question 3 of 5

The nurse is discussing dementia with the families of older adults. All of the following behaviors are reported. Which behavior is most suggestive of dementia?

Correct Answer: B

Rationale: Getting lost in a familiar area indicates significant spatial disorientation, a hallmark of dementia. Forgetting details, misplacing items, or color oversight are less specific.

Question 4 of 5

The nurse is caring for a client with immune thrombocytopenic purpura. Which client statements indicate a need for further teaching? Select all that apply.

Correct Answer: C,E

Rationale: ITP increases bleeding risk. Using a safety razor (
C) risks cuts, and ibuprofen (E) inhibits platelets, both requiring further teaching. Soft toothbrush (
A), safe walking (
B), and docusate (
D) are appropriate.

Question 5 of 5

Which response by the nurse would best assist the chemically impaired client to deal with issues of guilt?

Correct Answer: B

Rationale: This response encourages the client to get in touch with their feelings and utilize problem-solving steps to reduce guilt feelings.

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