NCLEX-PN
Safe and Effective Care Environment Nclex PN Questions
1. What is the appropriate ratio of cardiac compressions to ventilations in an adult client for one-person CPR?
- A. 5:01
- B. 1:05
- C. 15:02
- D. 2:15
Correct answer: C
Rationale: The correct answer is 15:2. For one-person CPR on an adult, the ratio of compressions to ventilations is 15:2. This ratio ensures adequate oxygenation while maintaining effective circulation. Choice A (5:1) and Choice B (1:5) are incorrect ratios and do not align with the recommended guidelines for adult CPR. Choice D (2:15) is also incorrect as it reverses the order of compressions and ventilations.
2. Which of the following nursing diagnoses might be appropriate as Parkinson's disease progresses and complications develop?
- A. Impaired Physical Mobility
- B. Dysreflexia
- C. Hypothermia
- D. Impaired Dentition
Correct answer: A
Rationale: As Parkinson's disease progresses and complications develop, impaired physical mobility is a relevant nursing diagnosis due to symptoms like a shuffling gait and rigidity that can impair movement. Dysreflexia is not typically associated with Parkinson's disease; it is more commonly seen in spinal cord injuries. Hypothermia is a condition of low body temperature and is not directly related to Parkinson's disease progression. Impaired Dentition involves issues with teeth and oral health, which are not specific to Parkinson's disease complications.
3. Nail and foot care are essential in meeting the basic hygiene needs of clients. Important assessments by the nurse in this area include:
- A. a full-body assessment is not specific to nail and foot care.
- B. the essential lab work of the client is not related to nail and foot assessments.
- C. the nail beds and the tissue surrounding the nails.
- D. foot corns and calluses only neglect other important aspects of nail and foot care.
Correct answer: C
Rationale: The correct answer is to assess the nail beds and the tissue surrounding the nails. This assessment is crucial to identify abnormal discoloration, lesions, paronychia, dryness, breaks in the skin, pressure areas, or any other unusual appearances. Choice A is incorrect as a full-body assessment is broader and not specific to nail and foot care. Choice B is incorrect as lab work is not directly related to nail and foot assessments. Choice D is incorrect as it focuses only on foot corns and calluses, neglecting other important aspects of nail and foot care.
4. When a drug is listed as Category X and prescribed to women of child-bearing age/capacity, the nurse and the interdisciplinary team should counsel the client that:
- A. Pregnancy tests are not reliable while taking the drug.
- B. She must use a reliable form of birth control.
- C. She should not take the Category X drug on days she has intercourse.
- D. She must follow up with an endocrinologist.
Correct answer: B
Rationale: When a drug is categorized as Category X, it signifies that there are significant risks of fetal abnormalities if taken during pregnancy. For this reason, women of child-bearing age/capacity should use reliable forms of birth control to prevent pregnancy while on the medication. This ensures that the client avoids the potential harm to the fetus. Option A is incorrect because pregnancy tests are not unreliable due to the drug, but rather the risk is related to potential harm to the fetus. Option C is incorrect as avoiding the drug only on days of intercourse does not provide sufficient protection against pregnancy. Option D is incorrect as the need for an endocrinologist is not directly related to the use of Category X drugs.
5. Which of the following statements indicates that the provider understands how to promote rest and sleep for the client?
- A. If you would prefer not to be disturbed, we can postpone all vital signs and assessments until tomorrow morning.
- B. With your physical therapy appointments, you cannot nap more during the day even if your sleep is often interrupted at nighttime.
- C. I can try to incorporate any sleep rituals or an ideal bedtime into your routine.
- D. We cannot group together medications, assessments, and other interventions so you may have multiple interruptions at night.
Correct answer: C
Rationale: The correct answer is, 'I can try to incorporate any sleep rituals or an ideal bedtime into your routine.' To promote rest and sleep, the provider should consider incorporating the client's preferred sleep rituals or bedtime routine. This statement shows an understanding of the importance of individualizing care to promote restful sleep. Choices A, B, and D do not directly address promoting rest and sleep. Choice A focuses on postponing assessments, Choice B addresses napping during the day, and Choice D mentions multiple interruptions at night, none of which directly support promoting rest and sleep for the client.
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