NCLEX-PN
2024 PN NCLEX Questions Questions
Extract:
Question 1 of 5
During a well-baby examination, the nurse measures the head circumference, and it is the same as the chest circumference. On the basis of this measurement, what action should the nurse take?
Correct Answer: A
Rationale: The head circumference growth rate during the first year is approximately 0.4 inches (1 cm) per month. By 10 to 12 months of age, the infant's head and chest circumferences are equal. In this case, where the head circumference matches the chest circumference, it is a normal finding in infants around 10-12 months.
Therefore, the most appropriate action is to document these measurements in the infant's health care record. Suspecting hydrocephalus or suggesting a skull x-ray would be premature and not indicated based on this measurement. Similarly, telling the mother that the infant is growing faster than expected is not accurate and could cause unnecessary concern.
Question 2 of 5
Distribution of a drug to various tissues depends on the amount of cardiac output to each type of tissue. Which tissue would receive the highest amount of cardiac output and thus the highest amount of a drug?
Correct Answer: D
Rationale: The tissue that would receive the highest amount of cardiac output and thus the highest amount of a drug is the myocardium. Highly perfused tissues include vital organs like the brain, heart, kidneys, adrenal glands, and liver. The myocardium, being part of the heart, receives a significant amount of cardiac output.
Choices A (skin) and B (adipose tissue) are poorly perfused tissues and would not receive high amounts of cardiac output.
Choice C (skeletal muscle) is also less perfused compared to the myocardium.
Question 3 of 5
When preparing a client for surgery, the graduate nurse realizes the operative permit has not been signed. The client tells the nurse he understands the procedure but received his preoperative medication approximately 10 minutes prior. The appropriate action would be:
Correct Answer: D
Rationale: The correct action in this scenario is to call the surgical area and explain that the surgery will have to be cancelled. The client must sign the operative permit or any other legal document before receiving preoperative medication. Without the signed permit, the surgery cannot proceed to ensure the client's safety and legal compliance. Having the client sign the permit, witnessing the form after the client signs it, or having someone else sign the form are all inappropriate actions and do not address the legal requirement of the client's signature before receiving preoperative medication.
Question 4 of 5
When educating an obese client about nutritional needs and weight loss, which of the following should not be included?
Correct Answer: D
Rationale: When educating an obese client about nutritional needs and weight loss, it is important to cover factors such as knowledge of food and food products, the development of a positive mental attitude, and the importance of adequate exercise. These aspects contribute to a holistic approach to weight management. However, recommending the client to start a fast weight-loss diet should not be included. Fast weight-loss diets can be harmful, leading to health risks, nutrient deficiencies, and unsustainable outcomes. It is crucial to advocate for gradual, sustainable weight loss strategies to ensure long-term success and overall well-being.
Therefore, starting a fast weight-loss diet is the least appropriate option among the choices provided.
Question 5 of 5
A nurse is trying to motivate a client toward more effective management of a therapeutic regimen. Which of the following actions by the nurse is most likely to be effective in increasing the client's motivation?
Correct Answer: C
Rationale:
To effectively motivate the client, it is important to educate them about the disorder at their level of understanding. This helps the client comprehend the importance of the therapeutic regimen and empowers them to actively participate in their treatment.
Choice A, determining if the client has any family or friends living nearby, may provide social support but is less likely to directly impact the client's motivation compared to educating them about their condition. Developing a concise discharge plan, as in choice B, is crucial for continuity of care but may not directly enhance the client's motivation as effectively as providing education tailored to their level of understanding. Making a referral for follow-up, as in choice D, is important for ongoing care but may not have the same immediate impact on the client's motivation as educating them about their condition.