NCLEX-PN
Nclex Exam Cram Practice Questions
1. When evaluating the lab work of a client in hepatic coma, which of the following lab tests is most important?
- A. blood urea nitrogen
- B. serum calcium
- C. serum ammonia
- D. serum creatinine
Correct answer: C
Rationale: When a client is in hepatic coma due to liver failure, the liver cannot metabolize amino acids completely, leading to elevated ammonia levels. Increased ammonia can cause brain-tissue irritation, worsening the coma. Therefore, monitoring serum ammonia levels is crucial in assessing the severity of hepatic coma. Choices A, B, and D are less relevant in the context of hepatic coma. Blood urea nitrogen primarily assesses kidney function, serum calcium levels are not directly related to hepatic coma, and serum creatinine is more indicative of kidney function rather than liver function in this scenario.
2. In an emergency situation where a client is unconscious and requires immediate surgery, what action is necessary with regard to informed consent?
- A. The healthcare team will proceed with the surgery as consent is not needed in emergencies.
- B. The healthcare team will wait until the client's family can be contacted for consent.
- C. The healthcare team will contact the hospital clergy to provide informed consent.
- D. The healthcare team will obtain consent from the client's legal guardian before proceeding.
Correct answer: A
Rationale: In emergency situations where obtaining consent is not possible due to the client's condition, healthcare providers are allowed to perform life-saving procedures without informed consent. It is assumed that the client would want to receive necessary treatment to save their life. Therefore, the correct action is for the healthcare team to proceed with the surgery as consent is not needed. Waiting to contact the client's family for consent can delay life-saving treatment, risking the client's life. Contacting the hospital clergy for consent is unnecessary and can cause further delays. Obtaining consent from the client's legal guardian is not feasible in this critical situation and may lead to a delay in providing essential care.
3. A nurse is reading the nurse practice act for the state in which she is employed. The nurse uses the information in this act for which purpose?
- A. To understand hospital and long-term care facility policies
- B. To know the scope of practice for nurses
- C. To identify health care policies in her state
- D. To be aware of the role of the licensed nurse
Correct answer: D
Rationale: The correct answer is 'To be aware of the role of the licensed nurse.' Nurse practice acts outline the scope of practice for nurses, defining what constitutes nursing practice and the role of licensed nurses. Choice A is incorrect because hospital and long-term care facility policies are institution-specific and not typically covered in the nurse practice act. Choice B is incorrect as the scope of practice for nurses is a part of the nurse practice act, but it's not the sole purpose for a nurse to refer to it. Choice C is incorrect as health care policies in a state are governed by other legislative acts, not the nurse practice act.
4. Which of the following foods should be avoided by clients who are prone to developing heartburn as a result of gastroesophageal reflux disease (GERD)?
- A. lettuce
- B. eggs
- C. chocolate
- D. butterscotch
Correct answer: C
Rationale: The correct answer is chocolate. Ingestion of chocolate can reduce lower esophageal sphincter (LES) pressure, leading to reflux and clinical symptoms of GERD. Lettuce and eggs do not significantly affect LES pressure, making them less likely to trigger GERD symptoms. Butterscotch, like lettuce and eggs, does not have a notable effect on LES pressure, so it is not as likely to worsen GERD symptoms as chocolate. Therefore, chocolate is the food to be avoided by clients prone to heartburn due to GERD.
5. During the change of shift, the oncoming nurse notes a discrepancy in the number of Percocet (Oxycodone) listed and the number present in the narcotic drawer. The nurse's first action should be to:
- A. Notify the hospital pharmacist
- B. Notify the nursing supervisor
- C. Notify the Board of Nursing
- D. Notify the director of nursing
Correct answer: B
Rationale: The first action the nurse should take is to report the finding to the nursing supervisor and follow the chain of command. Notifying the nursing supervisor allows for immediate action within the facility to address the discrepancy. If it is found that the pharmacy is in error, then notifying the hospital pharmacist (Choice A) would be appropriate. Choices C and D, notifying the Board of Nursing and the director of nursing, are not the initial steps to take. These options may be necessary if theft is suspected or if the facility's internal response is inadequate. Therefore, they are incorrect answers.
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