NCLEX-PN
NCLEX Trainer Test 2 Questions
Extract:
Question 1 of 5
While monitoring the urine specific gravity of a client with a head injury, the nurse notes that the client's specific gravity is 1.004 . The most likely explanation for this finding is:
Correct Answer: D
Rationale: A low specific gravity (1.004) suggests dilute urine, common in diabetes insipidus due to impaired ADH secretion, often seen in head injuries.
Question 2 of 5
An involuntary psychiatric patient asks the nurse to mail his letter to the President. He states that the letter will make the President regret his actions to prevent homosexuals from serving in the military. Which of the following responses by the nurse is BEST?
Correct Answer: D
Rationale: Mailing the letter respects the patient’s communication rights while addressing potential concerns. Options A, B, and C violate autonomy or privacy.
Extract:
A patient is being treated in the telemetry unit for cardiac disease. The patient is to receive propranolol hydrochloride (Inderal) 20 mg PO at 9 AM. The nurse finds him wheezing with a nonproductive cough and shortness of breath.
Question 3 of 5
INITIALLY, the nurse should
Correct Answer: A
Rationale: Strategy: Determine the outcome of each answer choice. (1) correct-side effects include increased airway resistance, patient is experiencing bronchospasm, should assess then call the physician (2) should assess the patient's condition first (3) experiencing a side effect, medication should not be given (4) medication should be held, experiencing a side effect
Extract:
Question 4 of 5
The nurse is caring for a 14-year-old girl admitted with an acute exacerbation of ulcerative colitis.
Correct Answer: D
Rationale: Involving the adolescent in planning her daily schedule promotes autonomy and control, which is developmentally appropriate and therapeutic for managing chronic illness. Rooming in, school programs, and friend visits are supportive but less empowering for self-management.
Question 5 of 5
A 4 month-old child taking digoxin (Lanoxin) has a blood pressure of 92/78; resting pulse of 78 BPM; respirations 28 and a potassium level of 4.8 mEq/L. The client is irritable and has vomited twice since the morning dose of digoxin. Which finding is most indicative of digoxin toxicity?
Correct Answer: A
Rationale: Bradycardia. The most common sign of digoxin toxicity in children is bradycardia (heart rate below 100 BPM in an infant).