NCLEX-PN Practice Question 2022 with complete solutions

Chapter 5 Care of Special Populations Priority Concepts Caregiving, Health Disparities Question 1 Which teaching method is most effective when providing instruction to members of special populations? 1. Teach-back ...

Chapter 5 Care of Special Populations Priority Concepts Caregiving, Health Disparities Question 1 Which teaching method is most effective when providing instruction to members of special populations? 1. Teach-back 2. Video instruction 3. Written materials 4. Verbal explanation - ANSWER Answer 1 Question 2 Which is most appropriate when communicating with a transgender person? 1. Using preferred pronouns 2. Using their first name to address them 3. Using pronouns associated with birth sex 4. Anticipating the client's needs and making suggestions - ANSWER Answer 1 Question 3 The nurse is volunteering with an outreach program to provide basic health care for homeless people. Which finding, if noted, must be addressed first? 1. Blood pressure 154/72 mmHg. 2. Visual acuity of 20/200 in both eyes 3. Random blood glucose level of 206 mg/dL 4. Complaints of pain associated with numbness and tingling in both feet - ANSWER Answer 4 Question 4 The nurse is completing the admission assessment of a client who is intellectually disabled. Which part of the client encounter may require more time to complete? 1. The history 2. The physical assessment 3. The nursing plan of care 4. The readmission risk assessment - ANSWER Answer 1 Question 5 The nurse working in a correctional facility is caring for a new prisoner. The client asks about health risks associated with living in a prison. How would the nurse respond? 1. "Health care is very limited in the prison setting." 2. "Living in a prison isn't different than living at home." 3. "Living in a prison can predispose a person to different health conditions." 4. "Living in a prison is similar to living in a condominium complex or dormitory." - ANSWER Answer 3 Question 6 The nurse is caring for a female client in the emergency department who presents with a complaint of fatigue and shortness of breath. Which physical assessment finding, if noted by the nurse, warrant a need for follow-up? 1. Reddened sclera of the eyes 2. Dry flaking noted on the scalp 3. A reddish-purple mark on the neck 4. A scaly rash noted on the elbows and knees - ANSWER Answer 3 Question 7 The nurse working in a community outreach program for foster children plans care knowing that which health conditions are common in this population? Select all that apply. 1. Asthma 2. Claustrophobia 3. Sleep problems 4. Bipolar disorder 5. Aggressive behavior 6. Attention-deficit / hyperactivity disorder (ADHD) - ANSWER Answer 3, 4, 5, 6 Question 8 The nurse assisting in planning care for a military veteran must prioritize nursing interventions targeted at managing which condition, if present, that commonly occurs in this population? 1. Hypertension 2. Hyperlipidemia 3. Substance abuse disorder 4. Post-traumatic stress disorder - ANSWER Answer 4 Question 9 The nurse caring for a refugee considers which health care need a priority for this client? 1. Access to housing 2. Access to clean water 3. Access to transportation 4. Access to mental health care services - ANSWER Answer 4 Question 10 Which action by the nurse will best facilitate adherence to the treatment regimen for a client with a chronic illness? 1. Arranging for home health care 2. Focusing on managing a single illness at a time 3. Communicating with one provider only to avoid confusion for the client 4. Allowing the client to teach a support person about their treatment regimen - ANSWER Answer 1 Chapter 6 Ethical and Legal Issues Priority Concepts Ethics; Health Care Law Question 1 Which identifies accurate nursing documentation notations? Select all that apply. 1. The client slept through the night. 2. Abdominal wound dressing is dry and intact without drainage. 3. The client seemed angry when awakened for vital sign measurement. 4. The client appears to become anxious when it is time for respiratory treatments. 5. The client's left lower medial leg wound is 3 cm in length without redness, drainage, or edema. - ANSWER Answer 1, 2, 5 Question 2 The licensed practical nurse (LPN) enters a client's room and finds the client lying on the bathroom floor. The LPN calls the registered nurse, who checks the client thoroughly and then assists the client back into bed. The LPN completes an incident report, and the nursing supervisor and primary health care provider (PHCP) are notified of the incident. Which is the next nursing action regarding the incident? 1. Place the incident report in the client's chart. 2. Make a copy of the incident report for the PHCP. 3. Document a complete entry in the client's record concerning the incident. 4. Document in the client's record that an incident report has been completed. - ANSWER Answer 3 Question 3 An unconscious client, bleeding profusely, is brought to the emergency department after a serious accident. Surgery is required immediately to save the client's life. With regard to informed consent for the surgical procedure, which is the best action? 1. Call the nursing supervisor to initiate a court order for the surgical procedure. 2. Try calling the client's spouse to obtain telephone consent before the surgical procedure. 3. Ask the friend who accompanied the client to the emergency department to sign the consent form. 4. Transport the client to the operating department immediately without obtaining an informed consent. - ANSWER Answer 4 Question 4 The nurse arrives at work and is told to report (float) to the pediatric unit for the day because the unit is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the pediatric unit. Which is the appropriate nursing action? 1. Call the hospital lawyer. 2. Call the nursing supervisor. 3. Refuse to float to the pediatric unit. 4. Report to the pediatric unit and identify tasks that can be safely performed. - ANSWER Answer 4 Question 5 The nurse enters a client's room and notes that the client's lawyer is present and that the client is preparing a living will. The living will requires that the client's signature be witnessed, and the client asks the nurse to witness the signature. Which is the appropriate nursing action? 1. Decline to sign the will. 2. Sign the will as a witness to the signature only. 3. Call the hospital lawyer before signing the will. 4. Sign the will, clearly identifying credentials and employment agency. - ANSWER Answer 1 Question 6 The nurse finds the client lying on the floor. The nurse calls the registered nurse, who checks the client and then calls the nursing supervisor and the primary health care provider (PHCP) to inform them of the occurrence. The nurse completes the incident report for which purpose? 1. Providing clients with necessary stabilizing treatments 2. A method of promoting quality care and risk management 3. Determining the effectiveness of interventions in relation to outcomes 4. The appropriate method of reporting to local, state, and federal agencies - ANSWER Answer 2 Question 7 The nurse observes that the client received pain medication 1 hour ago from another nurse, but the client still has severe pain. The nurse has previously observed this same occurrence several times. Based on the nurse practice act, the observing nurse would plan to take which action? 1. Report the information to the police. 2. Call the impaired nurse organization. 3. Talk with the nurse who gave the medication. 4. Report the information to a nursing supervisor. - ANSWER Answer 4 Question 8 A client has died, and the nurse asks a family member about the funeral arrangements. The family member refuses to discuss the issue. Which is the appropriate nursing action at this time? 1. Show acceptance of feelings. 2. Provide information needed for decision making. 3. Suggest a referral a mental health professional. 4. Remain with the family member without discussing funeral arrangements. - ANSWER Answer 4 Question 9 A nurse lawyer provides an education session to the nursing staff regarding client rights with an emphasis on invasion of these rights. The nurse lawyer asks a staff nurse to identify situation the represents an example of invasion of client privacy. Which situation, if identified by a staff nurse, indicates an understanding of a violation of this client right? 1. Threatening to place a client in restraints 2. Performing a surgical procedure without consent 3. Taking photographs of the client without consent 4. Telling the client that he or she cannot leave the hospital - ANSWER Answer 3 Question 10 An older woman is brought to the emergency department. When caring for the client, the nurse notes old and new ecchymotic areas on both of the client's arms and buttocks. The nurse asks the client how the bruises were sustained. The client, although reluctant, tells the nurse in confidence that her daughter frequently hits her if she gests in the way. Which is the appropriate nursing response? 1. "I have a legal obligation to report this type of abuse." 2. "I promise I won't tell anyone, but let's see what we can do about this." 3. "Let's talk about ways that will prevent your daughter from hitting you." 4. "This should not be happening. If it happens again, you must call the emergency department." - ANSWER Answer 1 Chapter 7 Prioritizing Client Care: Leadership, Delegation, and Emergency Response Planning Priority Concepts Leadership; Health Care Organizations Question 1 The nurse is recording a nursing hands-off (end-of-shift) report for a client. Which information needs to be included? 1. As-needed medications given that shift 2. Normal vital signs that have been the same since admission 3. All of the tests and treatments the clients has had since admission 4. Total number of scheduled medications that the client received on that shift. - ANSWER Answer 1 Question 2 The nurse is planning the client assignments for the day. Which is the most appropriate assignment for the assistive personnel (AP)? 1. A client who requires wound irrigation 2. A client who requires frequent ambulation 3. A client who is receiving continuous tube feedings 4. A client who requires frequent vital signs after a cardiac catheterization - ANSWER Answer 2 Question 3 The nurse employed in a long-term care facility is planning the client assignments for the shift. Which client would the nurse assign to the assistive personnel (AP)? 1. A client who requires a 24-hour urine collection 2. A client who requires twice-daily dressing changes 3. A client with diabetes mellitus who requires daily insulin and the reinforcement of dietary measures A client who has been placed on a bowel management program and requires rectal suppositories and a daily enema - ANSWER Answer 1 Question 4 The nurse is assigned to care for four clients. When planning client rounds, which client would the nurse check first? 1. A client in skeletal traction 2. A client who is dependent on a ventilator 3. A postoperative client preparing for discharge 4. A client admitted during the previous shift with a diagnosis of gastroenteritis - ANSWER Answer 2 Question 5 The nurse employed in an emergency department (ED) is assigned to assist with the triage of clients arriving at the ED. The nurse would assign priority to which client? 1. A client complaining of muscle ache, headache, and malaise 2. A client who twisted their ankle when they fell in-line skating 3. A client with a minor laceration on the index finger sustained while cutting an eggplant A client with chest pain who states that they just ate pizza that was made with a very spicy sauce - ANSWER Answer 4 Question 6 The nurse is educating a new nurse about mass casualty events (disasters). Which statement by the new nurse indicates a need for further teaching? Select all that apply. 1. "An event is termed a mass casualty when it overwhelms local medical capabilities." 2. "Mass casualty events do not require an increase in the number of staff that are needed." 3. "A mass casualty event occurs only within the health care facility and could endanger staff." 4. "Mass casualty events may require the collaboration of many local agencies to handle the situation." 5. "A mass casualty event occurs if a fight between visitors occurs in the emergency department." - ANSWER Answer 2, 3, 5 Question 7 The nurse is attending an agency orientation meeting about the nursing model of practice implemented in the facility. The nurse is told that the nursing model is a team nursing approach. Which of the following describes the team-based model of nursing practice? 1. A task approach method is used to provide care to clients. 2. Managed care concepts and tools are used when providing client care. 3. Nursing staff are led by the nurse when providing care to a group of clients. 4. A single registered nurse is responsible for providing nursing care to a group of clients. - ANSWER Answer 3 Question 8 A client experiences cardiac arrest. The nurse leader quickly responds to the emergency and assigns clearly defined tasks to the work group. In this situation, the nurse is implementing which leadership style? 1. Autocratic 2. Situational 3. Democratic 4. Laissez-faire - ANSWER Answer 1 Question 9 The nurse has delegated several nursing tasks to staff members. Which is the nurse's primary responsibility after the delegation of tasks? 1. Document that the task was completed. 2. Assign the tasks that were not completed to the next nursing shift. 3. Allow each staff member to make judgments when performing the tasks. 4. Perform follow-up with each staff member regarding the performance and outcome of the task. - ANSWER Answer 4 Question 10 The nurse is assigned to care for four clients. When planning client rounds, which client would the nurse collect data from first? 1. A client scheduled for a chest x-ray 2. A client requiring daily dressing changes 3. A postoperative client preparing for discharge 4. A client receiving oxygen who is having difficulty breathing - ANSWER Answer 4 Chapter 8 Fluids and Electrolytes Priority Concepts Cellular Regulation; fluids and Electrolytes Question 1 The nurse who is caring for a client with renal failure notes that the client is dyspneic and crackles are heard when listening to breath sounds in the lungs. Which additional sign / symptom would the nurse expect to note in this client? 1. Rapid weights loss 2. Flat hand and neck veins 3. A weak and thready pulse 4. An increase in blood pressure - ANSWER Answer 4 Question 2 The nurse is reviewing the health records of assigned clients. The nurse would plan care knowing that which client is at risk for a potassium deficit? 1. The client with Addison's disease 2. The client with metabolic acidosis 3. The client with intestinal obstruction 4. The client receiving nasogastric suction - ANSWER Answer 4 Question 3 The nurse reviews a client's electrolyte results and notes a potassium level of 5.5 mEq/L. The nurse understands that a potassium value at this level would be noted with which condition? 1. Diarrhea 2. Traumatic burn 3. Cushing's syndrome 4. Overuse of laxatives - ANSWER Answer 2 Question 4 The nurse reviews a client's electrolyte results and notes that the potassium level is 5.4 mEq/L. What would be nurse look for on the cardiac monitor as a result of this laboratory value? 1. ST elevation 2. Peaked P waves 3. Prominent U waves 4. Narrow, peaked T waves - ANSWER Answer 4 Question 5 The nurse is reading the primary health care provider's (PHCP's) progress notes in the client's record and sees that the PHCP has documented "insensible fluid loss of approximately 800 mL daily." Which client is at risk for this loss? 1. The client with a draining wound 2. The client with a urinary catheter 3. The client with a fast respiratory rate 4. The client with a nasogastric tube to low suction - ANSWER Answer 3 Question 6 The nurse is reviewing the health records of assigned clients. The nurse would plan care knowing that which client is at the least likely risk for the development of third-spacing? 1. The client with sepsis 2. The client with cirrhosis 3. The client with kidney failure 4. The client with diabetes mellitus - ANSWER Answer 4 Question 7 The nurse is reviewing the health records of assigned clients. The nurse would plan care knowing that which client is at risk for fluid volume deficit? 1. The client with cirrhosis 2. The client with ileostomy 3. The client with heart failure The client with decreased renal function - ANSWER Answer 2 Question 8 The nurse is caring for a client who has been taking diuretics on a long-term basis. Which finding would the nurse expect to note as a result of this long-term use? 1. Gurgling respirations 2. Increased blood pressure 3. Decreased hematocrit level 4. Increased specific gravity of the urine - ANSWER Answer 4 Question 9 The nurse reviews electrolyte values and notes a sodium level of 130 mEq/L. The nurse expects that this sodium level would be noted in a client with which condition? 1. The client with watery diarrhea 2. The client with diabetes insipidus 3. The client with an inadequate daily water intake 4. The client with the syndrome of inappropriate secretion of antidiuretic hormone - ANSWER Answer 4 Question 10 The nurse is caring for a client with leukemia and notes that the client has poor skin turgor and flat neck and hand veins. The nurse suspects hyponatremia. Which sign / symptom would the nurse expect to note in this client if hyponatremia is present? 1. Intense thirst 2. Slow bounding pulse 3. Dry mucous membranes 4. Postural blood pressure changes - ANSWER Answer 4 Question 11 The nurse is caring for a client with the diagnosis of hyperparathyroidism. Laboratory studies are performed and the serum calcium level is 12.0 mg / dL. Based on this laboratory value, the nurse would take which action? 1. Document the value in the client's record. 2. Inform the registered nurse of the laboratory value. 3. Place the laboratory result form in the client's record. 4. Reassure the client that the laboratory result is normal. - ANSWER Answer 2 Question 12 The nurse reviews the client's serum calcium level and notes that the level is 8.0 mg/dL. The nurse understands that which condition would cause this serum calcium level? 1. Prolonged bed rest 2. Adrenal insufficiency 3. Hyperparathyroidism 4. Excessive ingestion of vitamin D - ANSWER Answer 1 Question 13 The nurse is caring for a client with a suspected diagnosis of hypercalcemia. Which sign / symptom would be an indication of this electrolyte imbalance? 1. Twitching 2. Positive Trousseau's sign 3. Hyperactive bowel sounds 4. Generalized muscle weakness - ANSWER Answer 4 Question 14 The nurse is instructing a client on how to decrease the intake of calcium in the diet. The nurse would tell the client that which food item is least likely to contain calcium? 1. Milk 2. Butter 3. Spinach 4. Collard greens - ANSWER Answer 2 Question 15 The nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which prescribed medication would the nurse plan to assist in administering to the client? 1. Calcitonin 2. Calcium chloride 3. Calcium gluconate 4. Large doses of vitamin D - ANSWER Answer 1 Chapter 9 Acid-Base Balance Priority Concepts Acid-Base Balance; Oxygenation Question 1 A Client has the following laboratory values: a pH of 7.55, an HCO-3 level of 22 mEq/L, and a Pco2 of 30 mm Hg. Which action would the nurse plan to take? 1. Perform Allen's test 2. Prepare the client for dialysis 3. Administer insulin as prescribed 4. Encourage the client to slow down breathing - ANSWER Answer 4 Question 2 The nurse is told that the arterial blood gas (ABG) results indicate a pH of 7.50 and a Pco2 of 32 mm Hg. The nurse determines that these results are indicative of which acid-base disturbance? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis - ANSWER Answer 4 Question 3 A client is scheduled for blood to be drawn from the radial artery for an arterial blood gas (ABG) determination. The nurse assists with performing an Allen's test before drawing the blood to determine the adequacy of which? 1. Ulnar circulation 2. Carotid circulation 3. Femoral circulation 4. Brachial circulation - ANSWER Answer 1 Question 4 The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client closely for which acid-base disorder that is most likely to occur in this situation? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis - ANSWER Answer 2 Question 5 The nurse is caring for a client with severe diarrhea. The nurse monitors the client closely, understanding that this client is at risk for developing which acid-base disorder? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis Respiratory alkalosis - ANSWER Answer 1 Question 6 The nurse observes that a client with diabetic ketoacidosis is experiencing abnormally deep, regular, rapid respirations. How would the nurse correctly document this observation in the medical record? 1. Apnea 2. Bradypnea 3. Cheyne-Stokes 4. Kussmaul's respirations - ANSWER Answer 4 Question 7 The nurse is caring for a client with a diagnosis of chronic obstructive pulmonary disease (COPD). The nurse would monitor the client for which acid-base imbalance? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis - ANSWER Answer 3 Question 8 Which clients would the nurse determine to be at risk for development of metabolic alkalosis? Select all that apply. 1. Client with emphysema