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Questions 227

NCLEX-PN

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Extract:

A colleague came in to work in your unit with scent of alcohol in his uniform. When asked, he claimed that on his way to work, a gentleman accidentally spilled a glass of wine on his shirt. However, you noted that his breath smells alcohol.


Question 1 of 5

Which of the following nursing actions will be best for the nurse to take?

Correct Answer: B

Rationale: Informing the supervisor addresses potential impairment, ensuring patient safety.

Extract:

A child comes to the hospital after exposure to diphtheria and is given antitoxin.


Question 2 of 5

This type of immunity is known as:

Correct Answer: D

Rationale: In passive artificial immunity, an antibody made in another organism is injected into the infected or presumed infected person to provide immediate immunity.

Extract:


Question 3 of 5

Oxygen has been ordered for a client who was admitted to the hospital with congestive heart failure. Which assessment finding indicates that the oxygen has been effective?

Correct Answer: B

Rationale: A decreased respiratory rate indicates improved oxygenation, alleviating respiratory distress in congestive heart failure.

Question 4 of 5

A nurse is assessing an elderly patient for signs of dehydration. Which of the following findings is most indicative of dehydration?

Correct Answer: A

Rationale: Dry mucous membranes are a classic sign of dehydration, reflecting fluid loss. Increased urine output, hypertension, and weight gain suggest fluid overload or other conditions, not dehydration.

Question 5 of 5

An adult is admitted to a detoxification unit for withdrawal from alcohol. Which medication does the nurse expect will be ordered for the client upon admission?

Correct Answer: A

Rationale: Thiamin (vitamin B1) prevents Wernicke's encephalopathy, a common complication in alcohol withdrawal due to deficiency.

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