Reduction of Risk Potential NCLEX PN | Nurselytic

Questions 18

NCLEX-PN

NCLEX-PN Test Bank

Reduction of Risk Potential NCLEX PN Questions

Extract:


Question 1 of 5

The client that the nurse is ambulating becomes dizzy and feels faint. Place the nurse's actions in the correct order to prevent the client from falling.

Correct Answer: B,F,C,A,E,D

Rationale: The sequence ensures safety: call for help (
B), establish a stable stance (F), lower the client safely (C,
A), protect the head (E), and assess injuries (
D).

Question 2 of 5

After working with a client, an unlicensed assistive personnel (UAP) tells the nurse, "I have had it with that demanding client. I just can't do anything that pleases him. I'm not going in there again." The nurse should respond by saying

Correct Answer: C

Rationale: This response explains the client's behavior without belittling the UAP's feelings. The UAP is encouraged to contribute to the plan of care to help solve the problem.

Question 3 of 5

Which of these actions is the primary nursing intervention designed to limit transmission of a client's Salmonella infection?

Correct Answer: A

Rationale: Gram-negative bacilli cause Salmonella infection, and lack of sanitation is the primary means of contamination. Thorough handwashing can prevent the spread of salmonella.

Question 4 of 5

The client with DM is receiving care in the home for a foot ulcer. The home health nurse documents the narrative note illustrated. Which problem should be the nurse's priority on the return visit?

Question Image

Correct Answer: B

Rationale: Improper footwear increases the risk of injury or falls, which is critical for a diabetic client with reduced foot sensation and a healing ulcer.

Question 5 of 5

The nurse should perform which intervention when a client is restrained?

Correct Answer: C

Rationale: The minimum standard is to visually assess the restraint every 30 minutes. Documentation is typically performed per a checklist or flow sheet. The ends of the restraint are tied to a part of the bed that allows for position changes without unfastening them.

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