NCLEX PN Exam Cram - Nurselytic

Questions 58

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NCLEX PN Exam Cram Questions

Extract:


Question 1 of 5

A 22-year-old patient in a mental health lock-down unit under suicide watch appears happy about being discharged. Which of the following is probably happening?

Correct Answer: B

Rationale: In this scenario, it is concerning that a patient under suicide watch is happy about being discharged as it may indicate that the patient's suicide plan has advanced. This change in behavior should be taken seriously as it can signal an increased risk of self-harm.

Choices A, C, and D are less likely as the patient's happiness about discharge in this context is more indicative of a worsening situation rather than positive outcomes like being around family, clarifying future plans, or improving mood.

Question 2 of 5

Which of the following situations requires nurse intervention?

Correct Answer: C

Rationale: The correct answer is C. Patient confidentiality must be maintained at all times to respect the patient's privacy and dignity. Disclosing sensitive information like a patient's prognosis in a public setting violates confidentiality and can cause distress. The nurse should intervene in this situation and educate the nursing student about the importance of not discussing confidential patient information in public.

Choices A, B, and D do not involve breaching patient confidentiality and do not require immediate nurse intervention.
Choice A focuses on infection control measures, choice B relates to clinical assessment, and choice D is about the doctor's rounds, which are not urgent matters requiring immediate intervention.

Question 3 of 5

Which of the following symptoms is most characteristic of a client with lung cancer?

Correct Answer: B

Rationale: The most characteristic symptom of lung cancer is a persistent changing cough. This cough may worsen over time and may produce blood-tinged sputum. Exertional dyspnea (
Choice
A) is more common in chronic obstructive pulmonary disease (COP
D) due to airway obstruction. Air hunger and dyspnea (
Choice
C) are more typical of conditions like asthma. Cough with night sweats (
Choice
D) is commonly associated with tuberculosis rather than lung cancer.

Question 4 of 5

When teaching a patient with COPD pulmonary exercises, what should be done?

Correct Answer: A

Rationale: The correct answer is to teach pursed-lip breathing techniques. Pursed-lip breathing helps to decrease the volume of air expelled by keeping the airways open longer, making it easier for patients with COPD to breathe out. Encouraging heavy lifting exercises (
Choice
B) is not suitable for patients with COPD as it can lead to increased shortness of breath. Limiting exercises due to respiratory acidosis (
Choice
C) is not correct; instead, exercises should be tailored to the patient's tolerance. Taking breaks every 10-20 minutes (
Choice
D) is not specific to the management of COPD pulmonary exercises.

Question 5 of 5

A young female teenager describes a brutal assault and rape to the nurse on duty. Which of the following actions should the nurse take first?

Correct Answer: B

Rationale: In a situation where a patient describes a brutal assault and rape, the first priority should be to provide emotional support and create a safe and supportive environment. This helps the patient feel secure and cared for, which is crucial for their well-being at that moment. Checking with the case manager about police intervention should come after ensuring the patient's immediate emotional needs are addressed. Cleaning the patient's wounds, though important, can be secondary to providing emotional stabilization. Referring the patient to a counselor specializing in trauma is also crucial for long-term support, but the immediate focus should be on providing emotional support and stability.

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