NCLEX-PN
NCLEX Trainer Test 5 Questions
Extract:
A client with a new tracheotomy with a small amount of serosanguineous drainage on the dressing. A client who is responsive with a moderate amount of clear fluid draining from the NG tube. A client with a chest tube and dark red drainage in the collection chamber. A client who is unresponsive to verbal stimuli with the oral airway out of place.
Question 1 of 5
The nurse is caring for clients in the postanesthesia care unit (PACU). Which of the following clients require IMMEDIATE attention by the nurse?
Correct Answer: D
Rationale: Strategy: Remember the ABCs. (1) expected outcome, patient is stable (2) no indication of complications, stable client (3) expected outcome, gently 'milk' tubing in the direction of the drainage, if needed (4) correct-reinsert airway to maintain patent airway
Extract:
Question 2 of 5
The infant of a diabetic mother has a blood glucose of 90 mg/dL and a serum calcium level of 7.0 mg/dL. The nurse should anticipate that which of the following medications would be administered IV?
Correct Answer: D
Rationale: Hypocalcemia (7.0 mg/dL) in infants of diabetic mothers risks tetany; calcium gluconate is indicated. Options A, B, and C are inappropriate.
Question 3 of 5
A 69-year-old woman has been receiving total parenteral nutrition (TPN) for several weeks. If the TPN were abruptly discontinued, the nurse would expect the patient to exhibit
Correct Answer: C
Rationale: insulin levels remain high while glucose levels decline; results in hypoglycemia; will also see restlessness, headache, weakness, irritability, apprehension, lack of muscle coordination
Extract:
An 11-year-old boy with a minor head injury treated at the outpatient clinic.
Question 4 of 5
The nurse determines that further teaching is necessary if the mother makes which of the following statements? dimensional visualization of the vertebral canal.'
Correct Answer: B
Rationale: Strategy: Determine how each answer choice relates to a minor head injury. (1) expected for at least 24 hours (2) correct-unexpected, should be reported to physician immediately, also unexpected is blurred vision, drainage from ear or nose, weakness, slurred speech, worsening headache (3) expected for at least 24 hours (4) expected for at least 24 hours, should not get more intense
Extract:
Question 5 of 5
The nurse is caring for a client who is postoperative day 1 after a cesarean section. 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, such as endometritis, a serious complication post-cesarean section requiring immediate evaluation. Options B, C, and D are expected: incision pain, lochia rubra, and urine output 50 mL/hour are normal on day 1.