NCLEX-PN
NCLEX PN Exam Cram
1. Which of the following statements should the nurse use to best describe a very low-calorie diet (VLCD) to a client?
- A. "This diet can be used when there is close medical supervision."?
- B. "This is a long-term treatment measure that assists obese people who can't lose weight."?
- C. "The VLCD consists of solid food items that are pureed to facilitate digestion and absorption."?
- D. "A VLCD contains very little protein."?
Correct answer: A
Rationale: The correct answer is, "This diet can be used when there is close medical supervision."? Very low-calorie diets (VLCDs) are used in the clinical treatment of obesity under close medical supervision. The diet is low in calories, high in quality protein, and has a minimum of carbohydrates to spare protein and prevent ketosis. Choice B is incorrect because VLCDs are typically short-term interventions. Choice C is incorrect because VLCDs usually consist of nutritionally complete liquid formulations, not solid food items that are pureed. Choice D is incorrect because VLCDs actually contain a high quality of protein, although the overall caloric content is very low.
2. Which of the following organs of the digestive system has a primary function of absorption?
- A. stomach
- B. pancreas
- C. small intestine
- D. gallbladder
Correct answer: C
Rationale: The small intestine is the correct answer. It is the primary organ responsible for absorption in the digestive system. The stomach's primary function is to break down food through mechanical and chemical digestion. The pancreas produces digestive enzymes to aid in the breakdown of food. The gallbladder stores bile produced by the liver, which helps in the digestion of fats. However, neither the stomach, pancreas, nor gallbladder play the primary role of absorption in the digestive process, making them incorrect choices.
3. Which infection control measure is the priority for the nurse to implement in the care provided for a child admitted to the hospital with bacterial meningitis?
- A. Place the child in a private room
- B. Gowns and masks must be worn by all personnel in the child's room
- C. Visitors are restricted to parents only
- D. Hand washing is required by all personnel and visitors having contact with the child
Correct answer: B
Rationale: The priority control measure for the nurse to implement in caring for a child with bacterial meningitis is ensuring that gowns and masks are worn by all personnel in the child's room. This measure is crucial as the child with bacterial meningitis is contagious for at least 24 hours after starting antibiotics, necessitating airborne precautions to prevent the spread of infection to healthcare workers and other patients. Placing the child in a private room (Choice A) is important but secondary to preventing infection transmission. Restricting visitors to parents only (Choice C) is also significant but not as critical as ensuring proper infection control measures. While hand washing (Choice D) is essential, the immediate need to prevent airborne transmission in the child's room takes precedence.
4. What is the best nursing diagnosis for a client with newly diagnosed Diabetes Mellitus?
- A. Impaired Skin Integrity
- B. Knowledge Deficit: New Diabetes Diagnosis
- C. Alteration in Nutrition: More than Body Requirements
- D. Fluid Volume Deficit
Correct answer: B
Rationale: The correct answer is 'Knowledge Deficit: New Diabetes Diagnosis.' Newly diagnosed diabetics require education on their disease, medications, glucose testing, insulin injections, foot care, and sick-day plans. Choices A and D aim to prevent issues that do not currently exist for the client. Choice C, 'Alteration in Nutrition: More than Body Requirements,' is not the priority diagnosis for a newly diagnosed diabetic. While nutritional adjustments may be required for type I or type II diabetes, providing knowledge and education takes precedence at this stage.
5. A client admitted with an episode of bleeding esophageal varices is receiving propranolol (Inderal LA). The nurse knows to monitor for?
- A. Hypertension
- B. Hyperkalemia
- C. Bradycardia
- D. Arthralgia
Correct answer: C
Rationale: The correct answer is 'Bradycardia.' Propranolol is a beta-blocking agent used to decrease the heart rate. In the case of bleeding esophageal varices, propranolol is given to reduce the risk of bleeding by keeping the heart rate around 55 beats per minute. Monitoring for bradycardia is essential as the medication's intended effect is to lower the heart rate. Choices A, B, and D are incorrect because propranolol would not typically cause hypertension, hyperkalemia, or arthralgia.
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