NCLEX-PN
NCLEX Basic Care and Comfort Questions
Extract:
Question 1 of 5
To remove a client's gown when she has an intravenous line, the nurse should:
Correct Answer: C
Rationale: Threading the bag and tubing through the gown sleeve keeps the system intact. Opening an intravenous line causes a break in a sterile system and introduces the potential for infection. Cutting a gown off is not an alternative except in an emergency. IV gowns, which open along sleeves, are widely available.
Question 2 of 5
To ensure proper immobilization and increase client comfort when using a rigid splint:
Correct Answer: C
Rationale: Padding spaces in a rigid splint prevents pressure points, enhancing comfort and ensuring effective immobilization.
Question 3 of 5
The client uses a walker to ambulate with partial weight-bearing after foot surgery. What should the nurse observe when this client is using the walker correctly?
Correct Answer: A
Rationale: A: Elbows at 30 degrees indicate proper walker height. B: Bending over risks poor posture and falls. C: Lifting the walker prevents partial weight-bearing. D: Four-wheeled walkers are unsuitable for partial weight-bearing.
Question 4 of 5
The nurse is caring for the 11-month-old infant with bronchopulmonary dysplasia. The infant has 30% supplemental oxygen provided via a tracheostomy. Which action should the nurse take when the infant has a decline in oxygen saturation from 96% to 87% and appears anxious and restless?
Correct Answer: C
Rationale: C: Suctioning clears potential airway obstructions causing desaturation. A: ABGs are secondary if suctioning resolves distress. B: Increasing oxygen is ineffective with an occluded airway. D: Medication doesn't address airway issues.
Question 5 of 5
Which of the following statements from a client may indicate that they are at a higher risk for a fall?
Correct Answer: D
Rationale: A client who is visually impaired without their assistive devices could be at a higher risk for a fall when ambulating.