NCLEX-PN
Quizlet NCLEX PN 2023 Questions
Extract:
Question 1 of 5
A patient has a history of cardiac arrhythmia. A nurse has been ordered to give 2 units of blood to this patient. The nurse should take which of the following actions?
Correct Answer: D
Rationale: In patients with a history of cardiac arrhythmia, warming the blood before transfusion can help prevent additional arrhythmias. Cold blood can lead to arrhythmias and should be avoided. Administering pain medication (
Choice
A) is not directly related to the safe administration of blood. Informing the patient's family in person (
Choice
B) is important but not the immediate action required for safe transfusion. Decreasing the temperature of the blood to be given (
Choice
C) would increase the risk of cardiac arrhythmia, contrary to the goal of ensuring patient safety.
Question 2 of 5
When caring for a client with a possible diagnosis of placenta previa, which of the following admission procedures should the nurse omit?
Correct Answer: B
Rationale: The correct answer is 'enema.' Administering an enema to a client with placenta previa can dislodge the placenta, leading to an increased risk of bleeding and complications. It is crucial to avoid any interventions that may disrupt the placenta's positioning. Collecting urine and blood specimens are necessary for diagnostic purposes and monitoring, while a perineal shave is a routine procedure that does not pose a risk to the client with placenta previa.
Question 3 of 5
A patient has been diagnosed with diabetes mellitus. Which of the following is not a clinical sign of diabetes mellitus?
Correct Answer: D
Rationale: Polyphagia, polyuria, and metabolic acidosis are common clinical signs of diabetes mellitus. Polyphagia refers to excessive hunger, polyuria is excessive urination, and metabolic acidosis can occur due to poorly controlled diabetes. Lower extremity edema, on the other hand, is not a typical clinical sign of diabetes mellitus. Edema in the lower extremities is more commonly associated with conditions like heart failure or kidney disease rather than diabetes mellitus.
Question 4 of 5
If your patient is acutely psychotic, which of the following independent nursing interventions would not be appropriate?
Correct Answer: C
Rationale: When a patient is acutely psychotic, they may not be able to effectively participate in group therapy due to their altered mental state. Group settings can be overwhelming and may exacerbate the patient's symptoms.
Choices A, B, and D are appropriate interventions.
Choice A is correct as providing calmness through one-on-one interaction can be beneficial in establishing trust and reducing anxiety.
Choice B is also important as recognizing and managing the nurse's feelings can prevent further escalation of the patient's symptoms.
Choice D is relevant as listening and identifying causes of the patient's behavior can aid in understanding and providing appropriate care tailored to the patient's needs.
Question 5 of 5
A nurse is returning phone calls in a pediatric clinic. Which of the following reports most requires the nurse's immediate attention and phone call?
Correct Answer: A
Rationale: The correct answer is the 8-year-old boy with vomiting, slower movements, and a history of an atrioventricular shunt placement. This report requires immediate attention because the symptoms could indicate a blocked shunt, which is a serious medical condition needing urgent evaluation and intervention. Slower movements in the context of an atrioventricular shunt history could suggest increased intracranial pressure. The other choices involve less urgent issues: choice B describes post-exercise pain, choice C presents with a low-grade fever and headache that could be due to a mild infection, and choice D reports itching associated with a cast, which is a common issue and less critical compared to a potentially blocked shunt.