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NCLEX-PN FINAL | NCLEX-PN 202 5
EXAM QUESTIONS AND ANSWERS
100% SOLVED …GRADE A+
A 24 - year-old female client is scheduled for surgery in the morning. Which of the following is the primary responsibility of the nurse? Taking the vital signs Obtaining the permit Explaining the procedure Checking the lab work The nurse is working in the emergency room when a client arrives with severe burns of the left arm, hands, face, and neck. Which action should receive priority? Starting an IV Applying oxygen Obtaining blood gases Medicating the client for pain The nurse is visiting a home health client with osteoporosis. The client has a new prescription for alendronate (Fosamax). Which instruction should be given to the client? Rest in bed after taking the medication for at least 30 minutes Avoid rapid movements after taking the medication Take the medication with water only
Allow at least 1 hour between taking the medicine and taking other medications
Hematocrit of 33% WBC 2,000 per cubic millimeter Platelets 150,000 per cubic millimeter A 6 - month-old client is admitted with possible intussuception. Which question during the nursing history is least helpful in obtaining information regarding this diagnosis? “Tell me about his pain.” “What does his vomit look like?” “Describe his usual diet.” “Have you noticed changes in his abdominal size?” The nurse is assisting a client with diverticulosis to select appropriate foods. Which food should be avoided? Bran Fresh peaches Cucumber salad Yeast rolls A client has rectal cancer and is scheduled for an abdominal perineal resection. What should be the priority nursing care during the post-op period? Teaching how to irrigate the illeostomy Stopping electrolyte loss in the incisional area Encouraging a high-fiber diet Facilitating perineal wound drainage
The nurse is performing discharge teaching on a client with diverticulitis who has been placed on a low-roughage diet. Which food would have to be eliminated from this client’s diet? Roasted chicken Noodles Cooked broccoli Custard A client arrives in the emergency room with a possible fractured femur. The nurse should anticipate an order for: Trendelenburg position Ice to the entire extremity Buck’s traction An abduction pillow A client with cancer is to undergo an intravenous pyelogram. The nurse should: Force fluids 24 hours before the procedure Ask the client to void immediately before the study Hold medication that affects the central nervous system for 12 hours pre- and post-test Cover the client’s reproductive organs with an x-ray shield The nurse is caring for a client with a malignancy. The classification of the primary tumor is Tis. The nurse should plan care for a tumor: That cannot be assessed That is in situ
The client with diabetes is preparing for discharge. During discharge teaching, the nurse assesses the client’s ability to care for himself. Which statement made by the client would indicate a need for follow-up after discharge? “I live by myself.” “I have trouble seeing.” “I have a cat in the house with me.” “I usually drive myself to the doctor.” The client is receiving total parenteral nutrition (TPN). Which lab test should be evaluated while the client is receiving TPN? Hemoglobin Creatinine Blood glucose White blood cell count The client with a myocardial infarction comes to the nurse’s station stating that he is ready to go home because there is nothing wrong with him. Which defense mechanism is the client using? Rationalization Denial Projection Conversion reaction
Which laboratory test would be the least effective in making the diagnosis of a myocardial infarction? AST Troponin CK-MB Myoglobin The licensed practical nurse assigned to the post-partal unit is preparing to administer Rhogam to a postpartum client. Which woman is not a candidate for RhoGam? A gravida IV para 3 that is Rh negative with an Rh-positive baby A gravida I para 1 that is Rh negative with an Rh-positive baby A gravida II para 0 that is Rh negative admitted after a stillbirth delivery A gravida IV para 2 that is Rh negative with an Rh-negative baby The first exercise that should be performed by the client who had a mastectomy is: Walking the hand up the wall Sweeping the floor Combing her hair Squeezing a ball The client is scheduled for a Tensilon test to check for Myasthenia Gravis. Which medication should be kept available during the test?
The child with seizure disorder is being treated with Dilantin (phenytoin). Which of the following statements by the patient’s mother indicates to the nurse that the patient is experiencing a side effect of Dilantin therapy? “She is very irritable lately.” “She sleeps quite a bit of the time.” “Her gums look too big for her teeth.” “She has gained about 10 pounds in the last 6 months.” A 5 - year-old is admitted to the unit following a tonsillectomy. Which of the following would indicate a complication of the surgery? Decreased appetite A low-grade fever Chest congestion Constant swallowing A 6 - year-old with cerebral palsy functions at the level of an 18 - month- old. Which finding would support that assessment? She dresses herself. She pulls a toy behind her. She can build a tower of eight blocks. She can copy a horizontal or vertical line.
Which information obtained from the mother of a child with cerebral palsy most likely correlates to the diagnosis? She was born at 42 weeks gestation. She had meningitis when she was 6 months old. She had physiologic jaundice after delivery. She has frequent sore throats. A 10 - year-old is being treated for asthma. Before administering Theodur, the nurse should check the: Urinary output Blood pressure Pulse Temperature An elderly client is diagnosed with ovarian cancer. She has surgery followed by chemotherapy with a fluorouracil (Adrucil) IV. What should the nurse do if she notices crystals and cloudiness in the IV medication? Discard the solution and order a new bag Warm the solution Continue the infusion and document the finding Discontinue the medication The client is diagnosed with multiple myoloma. The doctor has ordered cyclophosphamide (Cytoxan). Which instruction should be given to the client?
Nausea often results from taking oral contraceptives and antibiotics. Toxicity can result when taking these two medications together. Antibiotics can decrease the effectiveness of oral contraceptives, so the client should use an alternate method of birth control. A 60 - year-old diabetic is taking glyburide (Diabeta) 1.25mg daily to treat Type II diabetes mellitus. Which statement indicates the need for further teaching? “I will keep candy with me just in case my blood sugar drops.” “I need to stay out of the sun as much as possible.” “I often skip dinner because I don’t feel hungry.” “I always wear my medical identification.” The physician prescribes regular insulin, 5 units subcutaneous. Regular insulin begins to exert an effect: In 5 – 10 minutes In 10–20 minutes In 30–60 minutes In 60 – 120 minutes Vitamin K (aquamephyton) is administered to a newborn shortly after birth for which of the following reasons? To prevent dehydration To treat infection To replace electrolytes To facilitate clotting
The client with an ileostomy is being discharged. Which teaching should be included in the plan of care? Use Karaya powder to seal the bag. Irrigate the ileostomy daily. Stomahesive is the best skin protector. Neosporin ointment can be used to protect the skin. The client has an order for FeSo4 liquid. Which method of administration would be best? Administer the medication with milk Administer the medication with a meal Administer the medication with orange juice Administer the medication undiluted The client arrives in the emergency room with a hyphema. Which action by the nurse would be best? Elevate the head of the bed and apply ice to the eye Place the client in a supine position and apply heat to the knee Insert a Foley catheter and measure the intake and output Perform a vaginal exam and check for a discharge The nurse is making assignments for the day. Which client should be assigned to the nursing assistant?
The client is admitted following repair of a fractured femur with cast application. Which nursing assessment should be reported to the doctor? Pain Warm toes Pedal pulses rapid Paresthesia of the toes Which would be an expected finding during injection of dye with a cardiac catheterization? Cold extremity distant to the injection site Warmth in the extremity Extreme chest pain Itching in the extremities Which action by the healthcare worker indicates a need for further teaching? The nursing assistant wears gloves while giving the client a bath. The nurse wears goggles while drawing blood from the client. The doctor washes his hands before examining the client. The nurse wears gloves to take the client’s vital signs. The client is having electroconvulsive therapy for treatment of severe depression. Which of the following indicates that the client’s ECT has been effective?
The client loses consciousness. The client vomits. The client’s ECG indicates tachycardia. The client has a grand mal seizure. A 5 - year-old is being tested for pinworms. To collect a specimen for assessment of pinworms, the nurse should teach the mother to: Examine the perianal area with a flashlight 2 – 3 hours after the child is asleep and to collect any eggs on a clear tape Scrape the skin with a piece of cardboard and bring it to the clinic Obtain a stool specimen in the afternoon Bring a hair sample to the clinic for evaluation Which instruction should be given regarding the medication used to treat enterobiasis (pinworms)? Treatment is not recommended for children less than 10 years of age. The entire family should be treated. Medication therapy will continue for 1 year. Intravenous antibiotic therapy will be ordered. Which client should be assigned to the pregnant licensed practical nurse? cancer The client who just returned after receiving linear accelerator radiation therapy for lung The client with a radium implant for cervical cancer
A client in the family planning clinic asks the nurse about the most likely time for her to conceive. The nurse explains that conception is most likely to occur when: Estrogen levels are low. Lutenizing hormone is high. The endometrial lining is thin. The progesterone level is low. A client tells the nurse that she plans to use the rhythm method of birth control. The nurse is aware that the success of the rhythm method depends on the: Age of the client Frequency of intercourse Regularity of the menses Range of the client’s temperature A client with diabetes asks the nurse for advice regarding methods of birth control. Which method of birth control is most suitable for the client with diabetes? Intrauterine device Oral contraceptives Diaphragm Contraceptive sponge The doctor suspects that the client has an ectopic pregnancy. Which symptom is consistent with a diagnosis of ectopic pregnancy? Painless vaginal bleeding
Abdominal cramping Throbbing pain in the upper quadrant Sudden, stabbing pain in the lower quadrant The nurse is teaching a pregnant client about nutritional needs during pregnancy. Which menu selection will best meet the nutritional needs of the pregnant client? Hamburger pattie, green beans, French fries, and iced tea Roast beef sandwich, potato chips, baked beans, and cola Baked chicken, fruit cup, potato salad, coleslaw, yogurt, and iced tea Fish sandwich, gelatin with fruit, and coffee The client with hyperemesis gravidarum is at risk for developing: Respiratory alkalosis without dehydration Metabolic acidosis with dehydration Respiratory acidosis without dehydration Metabolic alkalosis with dehydration A client with a fractured hip has been placed in traction. Which statement is true regarding balanced skeletal traction? Balanced skeletal traction: Utilizes a pin through bones Requires that both legs be secured Utilizes Kirschner wires Is used primarily to heal the fractured hips
