NCLEX-PN
Nclex PN Questions and Answers
1. During an emergency procedure, is the surgical timeout a requirement?
- A. The surgical timeout should be performed by the surgical team unless it would cause a delay leading to injury or death.
- B. No, the timeout is not necessary during an emergency procedure.
- C. No, the surgical timeout is not required in emergency procedures.
- D. Yes, the surgical timeout must be performed in all cases.
Correct answer: A
Rationale: During an emergency procedure, the surgical timeout should be performed unless doing so would cause a delay leading to injury or death. This is because the primary goal during an emergency is to swiftly address the critical situation. Choice B is incorrect as it implies that the timeout is not necessary, which is not accurate. Choice C is also incorrect as it suggests that the timeout is not required in emergency procedures, disregarding safety protocols. Choice D is incorrect as it wrongly states that the timeout must be performed in all cases without considering the potential risks associated with delays during emergencies.
2. A test that can correctly identify those who do not have a given disease is:
- A. specific.
- B. sensitive.
- C. negative culture
- D. marginal finding.
Correct answer: A
Rationale: The correct answer is 'specific.' Specificity refers to the ability of a test to correctly identify individuals who do not have a particular disease. In this case, when the client's lab culture report is negative for the suspected infection, a specific test would correctly identify that the client does not have the disease. 'Sensitive' (Choice B) is incorrect as sensitivity refers to the ability of a test to correctly identify individuals who do have the disease. 'Negative culture' (Choice C) is incorrect as it does not describe the test's ability but rather the result itself. 'Marginal finding' (Choice D) is irrelevant to the concept being tested in this question.
3. Which of the following is responsible for laws mandating the reporting of certain infections and diseases?
- A. Centers for Disease Control and Prevention (CDC)
- B. individual state laws
- C. National Institutes of Health (NIH)
- D. Health and Human Services (HHS)
Correct answer: B
Rationale: Individual state laws mandate the reporting of infectious diseases. The list of reportable diseases varies from state to state and is overseen by state health departments. While the CDC plays a significant role in disease surveillance, reporting infectious diseases is primarily governed by individual state laws. The CDC's role is to provide support, guidance, and expertise to state health departments. The National Institutes of Health (NIH) primarily focus on biomedical and health-related research, not on mandating disease reporting. Health and Human Services (HHS) is a federal department that oversees various agencies, but the responsibility for mandating disease reporting lies with individual states.
4. A nurse calls a health care provider to report that a client with congestive heart failure (CHF) is exhibiting dyspnea and worsening of wheezing. The health care provider, who is in a hurry because of a situation in the emergency department, gives the nurse a telephone prescription for furosemide (Lasix) but does not specify the route of administration. What is the appropriate action on the part of the nurse?
- A. Calling the health care provider who gave the telephone prescription to clarify the prescription
- B. Administering the medication orally and clarifying the prescription once the health care provider has finished caring for the client in the emergency department
- C. Calling the nursing supervisor for assistance in determining the route of administration
- D. Administering the medication intravenously because this route is generally used for clients with CHF
Correct answer: A
Rationale: Telephone prescriptions involve a health care provider dictating a prescribed therapy over the telephone to the nurse. The nurse must clarify the prescription by repeating it clearly and precisely to the health care provider. The nurse then writes the prescription on the health care provider's prescription sheet or enters it into the electronic medical record. It is crucial not to interpret an unclear prescription or administer a medication by a route that has not been expressly prescribed. In this case, the nurse should call the health care provider who gave the telephone prescription to clarify the prescription, ensuring the correct route of administration is specified. Options B, C, and D are incorrect because administering the medication without clarification, seeking assistance from the nursing supervisor, or choosing an arbitrary route of administration can compromise patient safety and violate medication administration protocols.
5. A nurse is planning client assignments for the day. Which task should the nurse assign to the nursing assistant (unlicensed assistive personnel)?
- A. Recording the urinary output for a client with renal calculi whose urine must be strained
- B. Dressing change instructions for a client who had a mastectomy 2 days ago
- C. Reporting abnormal lab values to the health care provider for a client scheduled for a laparoscopic cholecystectomy
- D. Preprocedural teaching for a client scheduled for a cardiac stress test
Correct answer: A
Rationale: The nurse is legally responsible for client assignments and must assign tasks based on state nursing practice act guidelines and job descriptions provided by the employing agency. The nursing assistant is trained to measure, collect, and strain urine, making recording urinary output for a client with renal calculi a suitable task for the nursing assistant. This task falls within the nursing assistant's role description. Dressing change instructions for a client who had a mastectomy involve a higher level of skill and knowledge, beyond the scope of a nursing assistant. Reporting abnormal lab values to the health care provider for a client scheduled for a laparoscopic cholecystectomy requires interpretation and clinical judgment, which is typically not within the nursing assistant's role. Preprocedural teaching for a client scheduled for a cardiac stress test involves providing detailed information and education, which is usually the responsibility of a licensed nurse or other qualified healthcare provider.
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