The nurse on a medical-surgical unit is caring
for a client with an extensive wound infection.
The physician has ordered contact precautions
based on the wound culture results. The nurse
recognizes when caring for th
...
The nurse on a medical-surgical unit is caring
for a client with an extensive wound infection.
The physician has ordered contact precautions
based on the wound culture results. The nurse
recognizes when caring for this client that she
should wear disposable medical examination
gloves
a. upon entering the client’s room to provide
care.
b. when providing care within fve feet of the
client.
c. when anticipating a dressing change.
d. when the potential of contamination from
body fuids exists.
2. When administering magnesium to a preeclampsic pregnant woman, the nurse assesses
for signs and symptoms of magnesium toxicity. These include all of the following EXCEpT
a. absent refexes.
b. fetal heart rate of 120.
c. respirations < 12 per minute.
d. urine output < 30cc/hour.
3. The nurse is caring for a client diagnosed with
glaucoma. Which of the following medications, if prescribed for the client, should the
nurse question?
a. atropine sulfate (Isopto Atropine)
b. betaxolol (Betoptic)
c. pilocarpine (Ocusert pilo-20)
d. pilocarpine hydrochloride (Isopto Carpine)
4. Upon examining the mouth and throat of a
seven-year-old, the nurse observes the
following:
The mother asks the nurse if the child’s tonsils
should be removed as they are so large. The
nurse knows that the tonsils reach their maximum size between the ages of
a. 4 and 6.
b. 6 and 8.
c. 8 and 10.
d. 10 and 12.
5. The nurse is preparing to complete a neurological assessment on a client. The nurse is
aware that which of the following are included
when assessing a client using the Glasgow
Coma Scale? Select all that apply.
1. eye opening
2. motor response
3. pupil reaction
4. verbal performance
a. 1, 2, 3, 4
b. 1, 2, 4
c. 1, 4
d. 2, 3
25
NCLEX-RN_03_21-92.indd 26 11/30/12 9:26 AM
–NCLEX -RN PRACTICE TEST 1 –
6. When the nurse is able to take the client’s perspective into consideration and communicate
this understanding back to the client, the nurse
is using
a. assertiveness.
b. empathy.
c. sympathy.
d. transference.
7. A nurse administers 12 U of regular insulin
mixed with 34 U of NpH insulin to a diabetic
client at 7:00 a.m. At 12 noon the client is off
the unit at radiology when lunch trays arrive.
Which of the following is the most appropriate
action for the nurse to complete?
a. Contact the radiology department and ask
the RN to start an IV of 5% dextrose.
b. Request that the client be returned to the
unit to eat lunch if the testing is not
complete.
c. Save the lunch tray and have client eat when
he or she returns to the unit.
d. Take a glass of orange juice or milk to the
radiology department for the client at 12
noon.
8. A woman in preterm labor is admitted to the
hospital and given an intramuscular (IM)
injection of betamethasone. The nurse
explains to the client that betamethasone
a. lowers maternal blood pressure.
b. prevents fetal seizures.
c. promotes fetal lung maturation.
d. stops maternal contractions.
9. A nurse has asked an unlicensed nursing assistant to feed a client who is ordered a full liquid
diet. The nurse will instruct the nursing assistant that which of the following items are permitted on this type of diet? Select all that
apply.
1. ice cream
2. oatmeal
3. pudding
4. yogurt
a. 1, 4
b. 2, 3
c. 1, 3, 4
d. 1, 2, 4
10. The nurse is teaching a class to new mothers
about safe infant sleeping environments. The
nurse teaches that which of the following
increase the infant’s risk for sudden infant
death syndrome (SIDS)? Select all that apply.
1. sleeping with a pacifer
2. low birth weight
3. maternal smoking during pregnancy
4. being placed on back for sleep
a. 1, 2
b. 2, 3
c. 3, 4
d. 1, 4
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