NCLEX-PN
Nclex Practice Questions 2024 Questions
Extract:
Question 1 of 5
A client asks the nurse if all donor blood products are cross-matched with the recipient to prevent a transfusion reaction. Which of the following always requires cross-matching?
Correct Answer: A
Rationale: Corrected
Rationale: Packed red blood cells contain antigens and antibodies that must be matched between the donor and recipient to prevent transfusion reactions. Platelets, plasma, and granulocytes do not contain red blood cells, so they do not require cross-matching. Platelets are matched based on ABO compatibility, while plasma and granulocytes are not routinely cross-matched as they lack red cell antigens.
Question 2 of 5
A client with glomerulonephritis is placed on a low-sodium diet. Which of the following snacks is suitable for the client with sodium restriction?
Correct Answer: D
Rationale: The correct answer is a fresh peach. It is the most suitable snack for a client with sodium restriction as it is naturally low in sodium. Peanut butter cookies (choice
A), grilled cheese sandwich (choice
B), and cottage cheese and fruit (choice
C) contain higher amounts of sodium, making them unsuitable choices for someone on a low-sodium diet. Fresh fruits like peaches are excellent options for individuals on a low-sodium diet as they are not only low in sodium but also provide essential nutrients and hydration.
Question 3 of 5
In the context of milieu therapy, what is its primary purpose?
Correct Answer: D
Rationale: Milieu therapy aims to provide routine daily experiences to clients. By offering a structured and predictable environment, it helps individuals feel safe and secure, reducing disruptive behaviors. Exploring the client's perception of reality (choice
A) may be part of therapy but not the primary focus. Enhancing social interaction abilities (choice
B) and addressing maladaptive behaviors (choice
C) are important aspects of therapy but not the primary purpose of milieu therapy.
Question 4 of 5
A home health nurse is making preparations for morning visits. Which one of the following clients should the nurse visit first?
Correct Answer: B
Rationale: The correct answer is B. The client with congestive heart failure complaining of nighttime dyspnea should be seen first as airway management is a priority in nursing care. This client's symptoms indicate potential respiratory distress, requiring immediate attention.
Choices A, C, and D involve clients who are more stable and do not present with urgent or acute conditions that require immediate intervention.
Choice A with a client receiving tube feedings for a stroke may require attention, but the urgency of addressing potential respiratory distress in choice B takes precedence.
Choice C, a client who had a thoracotomy 6 months ago, unless presenting with acute distress, does not necessitate immediate attention.
Choice D, a client with Parkinson's disease, is usually a chronic condition that does not typically require immediate intervention for the described scenario.
Question 5 of 5
A 26-year-old single woman is knocked down and robbed while walking her dog one evening. Three months later, she presents at the crisis clinic, stating that she cannot put this experience out of her mind. She complains of nightmares, extreme fear of being outside or alone, and difficulty eating and sleeping. What is the best response by the nurse?
Correct Answer: B
Rationale:
Choice B is the best response as it provides empathy and encourages the client to talk about her experience, which can be therapeutic. This approach validates the client's feelings and offers support. By acknowledging the difficulty and fear experienced by the client, the nurse opens the door for the client to express her emotions and begin the process of coping with the trauma.
Choices A, C, and D do not address the emotional impact of the traumatic event or provide an opportunity for the client to express her feelings and concerns.
Choice A immediately jumps to medication without exploring other supportive interventions.
Choice C focuses on practical solutions without addressing the client's emotional needs.
Choice D suggests a drastic solution without considering the client's emotional state or preferences.