NCLEX-PN
NCLEX Trainer Test 9 Questions
Extract:
The nurse is caring for clients on a psychiatric unit and is suddenly faced with multiple issues.
Question 1 of 5
Which of the following situations require the nurse's IMMEDIATE attention?
Correct Answer: B
Rationale: Strategy: 'Require IMMEDIATE intervention' indicates that you are looking for the least stable situation. (1) should remove to quiet area, decrease environmental stimuli (2) correct-could indicate impending suicide, requires immediate follow-up (3) potential suicide is more immediate concern (4) command hallucination, potential suicide takes priority
Extract:
Question 2 of 5
The nurse is caring for a client with a history of chronic kidney disease who is receiving epoetin alfa (Epogen). Which of the following laboratory results would be of GREATest concern to the nurse?
Correct Answer: A
Rationale: A hemoglobin of 14 g/dL is too high for epoetin alfa therapy, increasing the risk of hypertension and thrombosis, requiring dose adjustment. Options B, C, and D are expected: potassium 4.5 mEq/L and calcium 9.0 mg/dL are normal, and creatinine 3.0 mg/dL is consistent with chronic kidney disease.
Question 3 of 5
A mother wants to switch her 9 month-old infant from an iron-fortified formula to whole milk because of the expense. Upon further assessment, the nurse finds that the baby eats table foods well, but drinks less milk than before. What is the best advice by the nurse?
Correct Answer: C
Rationale: Continue with the present formula. Switching to whole milk before 12 months can lead to allergies and lactose intolerance.
Question 4 of 5
The nurse is caring for a client who is postoperative day 1 after a laparoscopic cholecystectomy. 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-cholecystectomy requiring immediate evaluation. Options B, C, and D are expected: incision pain is normal, shoulder pain is from referred diaphragmatic irritation, and urine output 40 mL/hour is adequate.
Question 5 of 5
Which of the following is the BEST method for the nurse to use when evaluating the effectiveness of tracheal suctioning?
Correct Answer: D
Rationale: to assess the effectiveness of suctioning, auscultate the client's chest to determine if the adventitious sounds are cleared and to ensure that the airway is clear of secretions.