NCLEX-PN
NCLEX Questions on Health Promotion and Maintenance Questions
Extract:
Question 1 of 5
Who should receive the hepatitis A vaccine?
Correct Answer: C
Rationale: Hepatitis A is for individuals who travel or persons with chronic liver disease. Infants receive the hepatitis B vaccine at birth. DTaP is administered at 18 months of age. Individuals who come into contact with blood should be immunized against hepatitis B.
Question 2 of 5
When an elder client asks the nurse whether he will be capable of sexual activity in old age, the best response by the nurse is:
Correct Answer: A
Rationale:
To provide the best response, the nurse must identify what the elder is asking. Concern is being expressed about whether elders can engage in sexual activity. The most therapeutic response by the nurse is
Choice 1. In this choice, the nurse acknowledges that elders can physically engage in sexual activity and have no psychological barriers to the same. All of the other choices contain facts but are not the best initial response.
Choice 1 opens the conversation for the expression of further concerns about sexual issues.
Question 3 of 5
A 93 year-old female with a history of Alzheimer's Disease gets admitted to an Alzheimer's unit. The patient has exhibited signs of increased confusion and limited stability with gait. Moreover, the patient is refusing to use a w/c. Which of the following is the most appropriate course of action for the nurse?
Correct Answer: B
Rationale: Stimulation in the form of pictures may decrease signs of confusion.
Question 4 of 5
A patient has suffered a left CVA and has developed severe hemiparesis resulting in a loss of mobility. The nurse notices on assessment that an area over the patient's left elbow appears as non-blanchable erythema and the skin is intact. The nurse should score the patient as having which of the following?
Correct Answer: A
Rationale: Erythema with the skin intact can indicate a Stage I pressure ulcer.
Question 5 of 5
The teaching plan for a postpartum client who is about to be discharged should include which of the following instructions?
Correct Answer: D
Rationale: The vaginal discharge after birth is called lochia, and it changes from red (rubra) to serosa (clear) on the third postpartum day. If it returns to red or contains clots, it could signal impending hemorrhage or infection and the physician should be notified.