NCLEX-PN
Nclex Questions Management of Care
1. When managing time effectively, which of the following stimuli should the nurse respond to first?
- A. the physician's loud verbal direction
- B. the nursing supervisor who is going to a meeting
- C. unit staff leaving on a break
- D. the care needs of the returning postoperative client just exiting the elevator
Correct answer: D
Rationale: The correct answer is to attend to the care needs of the returning postoperative client just exiting the elevator first. In a healthcare setting, patient care should always take precedence, especially for complex or unstable clients requiring immediate assessment and care. The physician's loud verbal direction, the nursing supervisor going to a meeting, and unit staff leaving on a break are important but do not involve direct patient care. Therefore, the nurse should prioritize responding to the returning postoperative client to ensure their immediate needs are met.
2. The nurse is teaching a teenage female about preventing the transmission of genital herpes. Which of the following statements should the nurse include?
- A. "Do not sit on toilet seats without protection."?
- B. "Oral sex can transmit the virus."?
- C. "This infection can be transmitted via intercourse even when you do not feel ill."?
- D. "Try to drink lots of fluids after sex to flush the reproductive tract."?
Correct answer: C
Rationale: Genital herpes can be transmitted through oral, genital, and anal sex. It's crucial to understand that the infection can be spread through intercourse even when symptoms are not present. Option A is incorrect because genital herpes is not transmitted through toilet seats. Option B is correct as oral sex can transmit the virus. Option D is incorrect as drinking fluids after sex does not prevent the transmission of genital herpes.
3. What is a common side effect of Rifampin concerning the client's contact lenses?
- A. The client's urine might turn blue.
- B. The client remains infectious to others for 48 hours.
- C. The client's contact lenses might be stained orange.
- D. The client's skin might take on a crimson glow.
Correct answer: C
Rationale: The correct answer is that the client's contact lenses might be stained orange. Rifampin has the unusual effect of turning body fluids an orange color. Soft contact lenses might become permanently stained, making this an important side effect for the client to be aware of. Choices A, B, and D are incorrect. There is no documented effect of Rifampin causing the client's urine to turn blue, the client remaining infectious for 48 hours, or the client's skin taking on a crimson glow.
4. 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.
5. When ambulating a client with right-sided weakness, a nursing assistant should be positioned on which side of the client?
- A. Stands behind the client
- B. Positions the free hand on the client's shoulder
- C. Stands on the right side of the client
- D. Grasps the security belt in the midspine area of the small of the client's back
Correct answer: C
Rationale: When ambulating a client with right-sided weakness, the nursing assistant should stand on the affected side, which in this case is the client's right side. This position allows the assistant to provide proper support and assistance. Standing behind the client (Choice A) is incorrect as the assistant should be on the affected side. Positioning the free hand on the client's shoulder (Choice B) is a correct action as it helps in pulling the client toward them in case of a forward fall. Grasping the security belt in the midspine area of the small of the client's back (Choice D) is also correct to provide support and stability during ambulation.
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