NCLEX-PN
Nclex Practice Questions 2024 Questions
Extract:
Question 1 of 5
A nurse is teaching the mother of an 11-month-old infant how to clean the infant's teeth. The nurse tells the mother to take which action?
Correct Answer: C
Rationale: The correct action when cleaning an infant's teeth is to use water and a cotton swab to gently rub the teeth. This method helps in removing any food particles or plaque buildup without the risks associated with toothpaste ingestion. Using a small amount of toothpaste and a soft-bristle toothbrush is not recommended for infants as they may swallow the toothpaste, leading to potential fluoride ingestion issues. Using diluted fluoride and rubbing the teeth with a soft washcloth is unnecessary at this age since infants typically receive fluoride through other sources like formula. Dipping the infant's pacifier in maple syrup is highly inappropriate and poses a significant risk of tooth decay due to the high sugar content, which can harm the infant's teeth.
Question 2 of 5
The client with cirrhosis of the liver is receiving Lactulose. The nurse is aware that the rationale for the order for Lactulose is:
Correct Answer: C
Rationale: Lactulose is administered to the client with cirrhosis to lower ammonia levels, as it works by acidifying the colon, trapping ammonia for elimination in the stool.
Choices A, B, and D are incorrect because Lactulose does not have an effect on blood glucose, uric acid, or creatinine levels.
Therefore, the correct answer is to lower the ammonia level.
Question 3 of 5
The nurse is caring for a client scheduled for removal of a pituitary tumor using the transsphenoidal approach. The nurse should be particularly alert for:
Correct Answer: A
Rationale: During the removal of a pituitary tumor using the transsphenoidal approach, nasal congestion is a significant concern as it can further obstruct the airway. This can be due to mucosal swelling, bleeding, or edema resulting from the surgery. Nasal congestion requires immediate attention to prevent airway compromise. Abdominal tenderness, muscle tetany, and oliguria are not directly associated with the pituitary gland or the transsphenoidal approach, making them incorrect choices. Abdominal tenderness is more common in abdominal or pelvic surgeries due to intra-abdominal issues. Muscle tetany is related to electrolyte imbalances or neuromuscular disorders, not specific to pituitary surgery. Oliguria is a concern in renal-related conditions, not typically in pituitary tumor surgeries.
Question 4 of 5
After the client discusses her relationship with her father, the nurse says, "Tell me whether I am understanding your relationship with your father. You feel dominated and controlled by him?"? This is an example of:
Correct Answer: B
Rationale: Seeking consensual validation is the correct answer. Consensual validation is a technique used to check one's understanding of what the client has said. It involves confirming with the client whether the nurse's interpretation aligns with the client's feelings or thoughts. This process helps build rapport, trust, and a shared understanding between the nurse and the client. Verbalizing the implied (choice
A) refers to expressing the underlying or implicit meaning of a client's statement. Encouraging evaluation (choice
C) involves prompting the client to assess or judge a situation. Suggesting collaboration (choice
D) entails proposing working together with the client on a shared goal, which is not the primary focus in the scenario provided.
Question 5 of 5
A client with suspected renal disease is to undergo a renal biopsy. The nurse plans to include which statement in the teaching session?
Correct Answer: B
Rationale: The correct answer is to inform the client that portions of the renal biopsy procedure can cause pain or discomfort, particularly when the sample is being withdrawn. This prepares the client for any unpleasant sensations during the procedure. Answer A is incorrect because the client will be positioned lying down, not sitting up, during the exam, so this information is not relevant to include in the teaching session. Answer C is incorrect as anesthesia is commonly used to numb the area for a renal biopsy, reducing pain, so the client can expect to receive anesthesia. Answer D is incorrect because clients are usually instructed to refrain from eating or drinking for a period before the procedure to prevent any complications during the biopsy, not simply before the study.