NCLEX-PN
Nclex Exam Cram Practice Questions
1. What should be the first action upon the discovery of an electrical fire?
- A. Disconnect the electrical power if it can be done safely
- B. Smother the source with an object like a blanket
- C. Saturate the source with water or another liquid
- D. Immediately activate the fire alarm
Correct answer: A
Rationale: The correct initial action upon discovering an electrical fire is to disconnect the electrical power if it can be done safely. This helps prevent the fire from spreading through the electrical system. Smothering the fire with a blanket is not recommended for electrical fires as it can fuel the fire. Saturating the source with water or other liquids is also not advised as it can lead to electric shock or spread the fire. Activating the fire alarm is important, but it should be done after disconnecting the power to prevent further escalation of the fire.
2. Which of the following statements by a client indicates adequate understanding of preparation for a lipoprotein fractionation test?
- A. "I cannot eat or drink after midnight."?
- B. "I cannot eat for 12 hours before the test."?
- C. "I need to limit my fluid intake."?
- D. "I need to ingest a lipid solution."?
Correct answer: B
Rationale: The correct statement regarding preparation for a lipoprotein fractionation test is that the client cannot eat for 12 hours before the test. It is important to note that the client can drink an unrestricted amount of water. Limiting fluid intake is not necessary for this test. There is no need for the client to ingest a lipid solution as part of the preparation. Therefore, the other choices are incorrect.
3. The nurse manager of a quality improvement program asks a nurse in the neurological unit to conduct a retrospective audit. Which action should the auditing nurse plan to perform in this type of audit?
- A. Checking the crash cart to ensure that all needed supplies are readily available in case of an emergency
- B. Checking the documentation written by a new nursing graduate on her assigned clients at the end of the shift
- C. Reviewing neurological assessment checklists for all clients on the unit to ensure that these assessments are being conducted as prescribed
- D. Obtaining the assigned medical record from the hospital's medical record room to review documentation made during a client's hospital stay
Correct answer: D
Rationale: Quality improvement, also known as performance improvement, focuses on processes contributing to client safety and care outcomes. Retrospective audits involve reviewing medical records after discharge for compliance with standards. Concurrent audits assess staff compliance during a client's stay. Therefore, obtaining the medical record from the hospital's record room for review is crucial in a retrospective audit. Options A, B, and C are more suited for concurrent audits as they involve real-time assessment during a client's stay.
4. A nurse is assigned to care for four clients. Which client should the nurse assess first?
- A. A client scheduled for a colonoscopy
- B. A client with a tracheostomy who is receiving humidified oxygen via a tracheostomy mask
- C. A client preparing for discharge after surgery
- D. A client requiring a tube feeding through a gastrostomy tube
Correct answer: B
Rationale: The correct answer is a client with a tracheostomy who is receiving humidified oxygen via a tracheostomy mask. Airway management is always the priority in nursing care. Assessing this client first ensures that their airway is clear and oxygenation is adequate. Clients with compromised airways need immediate attention to prevent respiratory distress or failure. The other clients do not have immediate airway concerns and represent lower priorities in this scenario. Therefore, the nurse should prioritize assessing the client with the tracheostomy and oxygen therapy to maintain airway patency and adequate oxygenation.
5. A client turns her ankle. She is diagnosed as having a Pulled Ligament. This should be documented as a:
- A. sprain.
- B. strain.
- C. subluxation.
- D. dislocation.
Correct answer: B
Rationale: A sprain is the correct term for the excessive stretching of a ligament, which is what happens when a ligament is pulled. A strain involves muscle tissue. Subluxation refers to a partial dislocation, and dislocation is a complete displacement of bones in a joint. In this case, since it's a pulled ligament, the most appropriate term is a sprain.
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