NCLEX-PN
NCLEX PN Test Bank
1. The nurse should teach parents of small children that the most common type of first-degree burn is:
- A. scalding from hot bath water or spills
- B. contact with hot surfaces such as stoves and fireplaces
- C. contact with flammable liquids or gases resulting in flash burns
- D. sunburn from lack of protection and overexposure
Correct answer: D
Rationale: The most common type of first-degree burn in small children is sunburn, often due to lack of protection and overexposure to the sun. This type of burn highlights the importance of educating parents about using sunscreens and ensuring children are adequately protected from the sun's harmful rays. Choices A, B, and C describe scenarios that can lead to burns but are not the most common type of first-degree burn in small children, making them incorrect.
2. When a 17-year-old client arrives at the clinic suspecting a sexually transmitted infection, what information does the nurse provide concerning informed consent?
- A. She will need to sign an informed consent form.
- B. Her mother or father will need to be contacted for permission to treat her.
- C. A consent form is not needed if the problem is a sexually transmitted infection.
- D. Anyone over the age of 18 years may sign a consent form for her treatment.
Correct answer: A
Rationale: Informed consent is a person's agreement to allow something, such as a treatment, to be performed. A consent form is required even if the problem is a sexually transmitted infection. If the client is a minor, the minor may sign the informed consent form in specific situations, including seeking treatment for a sexually transmitted infection. In this case, the 17-year-old client is seeking examination and treatment for a sexually transmitted infection, so she will need to sign the informed consent form. Contacting her parents for permission is not required in this situation. Choice C is incorrect because a consent form is necessary regardless of the medical issue. Choice D is incorrect because the individual's age is not the determining factor; rather, it is the nature of the medical service being sought that dictates the need for informed consent.
3. A Roman Catholic client is preparing to have magnetic resonance imaging. He wants to wear his metal crucifix pendant while he is receiving the test. Which of the following is an appropriate response by the nurse?
- A. "Because it gives you comfort, you may wear it."?
- B. "It is a violation of religious rights to forbid it."?
- C. "I am sorry, but it is not safe for you to wear the crucifix during this test."?
- D. "You may wear it because it is important to you."?
Correct answer: C
Rationale: No metal objects may be worn while receiving magnetic resonance imaging due to safety risks involved with the strong magnet. The correct response by the nurse should prioritize the safety of the client. Allowing the client to wear the metal crucifix poses a risk of injury or interference with the imaging process. Option A is not appropriate as safety takes precedence over comfort in this situation. Option B is incorrect as it does not address the safety concerns associated with wearing metal objects during an MRI. Option D is also incorrect as it fails to acknowledge the safety issue involved and instead focuses solely on the importance to the client. It is important for the nurse to offer alternative forms of spiritual support that do not pose a risk during the MRI procedure.
4. Which of the following statements from a client may indicate that they are at a higher risk for a fall?
- A. "I would like to get out of bed but would like to put on my non-skid socks first."?
- B. "Can you make sure the two bedrails are raised before leaving the room?"?
- C. "I think I'm ready to walk a longer distance with the cane today."?
- D. "I need to get out of bed to go to the bathroom now. I cannot find my glasses but cannot wait."?
Correct answer: D
Rationale: The correct answer is 'I need to get out of bed to go to the bathroom now. I cannot find my glasses but cannot wait.' This statement indicates that the client is in a hurry and unable to find their glasses, which could increase the risk of a fall due to impaired vision. Choice A about putting on non-skid socks shows the client's awareness of fall prevention, reducing the risk. Choice B demonstrates the client's request for bedrails to be raised, which is a safety measure, reducing the risk as well. Choice C suggests the client's readiness to walk a longer distance with a cane, indicating progress in mobility but not necessarily a higher fall risk.
5. Which of the following is an appropriate nursing goal for a client at risk for nutritional problems?
- A. provide oxygen
- B. promote healthy nutritional practices
- C. treat complications of malnutrition
- D. increase weight
Correct answer: B
Rationale: The correct answer is to promote healthy nutritional practices. This goal focuses on preventive measures to address the client's nutritional risk. Providing oxygen (Choice A) is not directly related to addressing nutritional problems. Treating complications of malnutrition (Choice C) involves addressing the consequences rather than preventing or managing the nutritional problems. Increasing weight (Choice D) would only be appropriate if the client is underweight; it does not address the broader aspect of promoting overall healthy nutritional practices.
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