NCLEX-PN
Quizlet NCLEX PN 2023 Questions
Extract:
Question 1 of 5
Which of the following observations is most important when assessing a client's breathing?
Correct Answer: C
Rationale: The correct answer is the presence of breathing and adequacy of breathing. It is crucial to ensure that the client is not only breathing but also breathing adequately.
Choices A and D are incorrect as pulse rate and patient position are not the most critical observations when assessing a client's breathing. Pulse rate is more related to assessing circulation, and patient position is important but not as crucial as ensuring the client is breathing and breathing adequately.
Choice B is partially correct as breathing pattern is important, but the most critical observation is the adequacy of breathing. Adequacy of breathing ensures that the client is receiving enough oxygen to support proper body function and is the key focus during breathing assessment.
Question 2 of 5
Laboratory tests reveal the following electrolyte values for Mr. Smith: Na 135 mEq/L, Ca 8.5 mg/dL, Cl 102 mEq/L, and K 2.0 mEq/L. Which of the following values should the nurse report to the physician because of its potential risk to the client?
Correct Answer: B
Rationale: The correct answer is 'K.' Normal serum potassium levels range between 3.5 and 5.5 mEq/L. Mr. Smith's potassium level of 2.0 mEq/L is significantly below the normal range, indicating hypokalemia, which can lead to serious risks such as cardiac arrhythmias. The levels of sodium (Na), calcium (Ca), and chloride (Cl) are within normal ranges, so they do not pose an immediate risk to the client's health.
Therefore, the nurse should report the low potassium level to the physician for prompt intervention.
Question 3 of 5
A healthcare professional is assessing a patient in the rehab unit during shift change. The patient has sustained a TBI 3 weeks ago. Which of the following is the most distinguishing characteristic of a neurological disturbance?
Correct Answer: A
Rationale: Level of consciousness (LO
C) is the most crucial indicator of impaired neurological function. Changes in LOC can signify various neurological conditions, including traumatic brain injury. Short-term memory, while important, is not the most distinguishing characteristic of neurological disturbances. Babinski and Clonus signs are specific neurological tests that can provide information about upper motor neuron lesions but are not as generalizable as changes in LOC for assessing overall neurological status.
Question 4 of 5
What type of cells create exocrine secretions?
Correct Answer: C
Rationale: Acinar cells are responsible for creating exocrine secretions, such as enzymes and digestive juices. Alpha cells are found in the pancreas and are responsible for producing glucagon, beta cells produce insulin, and plasma cells are a type of white blood cell involved in immune responses.
Therefore, the correct answer is acinar cells, as they specifically produce exocrine secretions.
Question 5 of 5
Paula is a 32-year-old woman seeking evaluation and treatment for major depressive symptoms. A major nursing priority during the assessment process includes which of the following?
Correct Answer: B
Rationale: The correct answer is to consider the possibility of self-harm during the assessment process. This is crucial because unless the client is first assessed for self-harm or suicide potential, the necessary degree of vigilance in the client's environment may not be observed. While understanding the meaning of current stressors is important for treatment planning, ensuring the client's safety takes precedence. Motivation to participate in treatment and the presence of alcohol or other drug use are also important aspects to assess but ensuring the client's safety is the top priority in this scenario.