NCLEX-PN
Next Generation Nclex Questions Overview 3.0 ATI Quizlet
1. What is the most common cause of injury from a house fire?
- A. Explosion
- B. Falls from second-story windows
- C. Thermal damage to skin and body surfaces
- D. Inhalation injury
Correct answer: D
Rationale: Inhalation injury is the most common cause of injury from a house fire. When a fire occurs, the smoke produced contains harmful gases and particles that can be inhaled, leading to serious respiratory issues. This makes inhalation injury the primary concern during a house fire. Choices A, B, and C are less likely to be the primary cause of injury. While explosions may occur in some cases, inhalation of smoke and toxic fumes is generally the most prevalent danger. Falls from windows and thermal damage to the skin are also significant risks but typically occur after inhalation injuries in the sequence of events during a house fire.
2. The nurse is transferring a client from a wheelchair to the bed. Which is the correct procedure?
- A. Pull the client toward you, and pivot him on the unaffected limb.
- B. Pull the client toward you, and pivot him on the affected limb.
- C. Push the client toward the bed, and pivot him on the affected limb.
- D. Stand the client on both legs, and push him toward the bed.
Correct answer: A
Rationale: When transferring a client from a wheelchair to the bed, the correct procedure is to pull the client toward you, which reduces workload force. By pivoting the client on the unaffected limb, strength is maintained to support the affected limb while moving towards the bed. Choice A is correct because it ensures a safe and effective transfer technique. Choices B, C, and D are incorrect as they involve incorrect positioning and movements that could potentially harm the client or increase the risk of injury. Pulling the client towards you puts less strain on your back and reduces the risk of injury. Pivoting on the unaffected limb ensures better support for the client's affected limb during the transfer process.
3. The nurse is caring for a non-English speaking client. The surgeon has asked the nurse to hurry up and prepare the client for their scheduled procedure, which is running late. Which of the following is least appropriate?
- A. Explain to the client's family member that the procedure may be delayed further.
- B. Inform the surgeon that the procedure will be delayed further because getting a staff interpreter will take additional time.
- C. Allow the client's family member to serve as the interpreter.
- D. Ask if a phone-service interpreting service is available to expedite the client preparation.
Correct answer: C
Rationale: Allowing the client's family member to serve as the interpreter is the least appropriate option. It is not recommended to rely on family members for interpretation as they may not be impartial, accurate, or trained to handle sensitive medical information. This can lead to misunderstandings, breaches in confidentiality, and compromised care. Choice A is a better option as it involves communication with the family member to manage expectations. Choice B is also appropriate as it prioritizes the need for a professional interpreter to ensure accurate communication. Choice D is a valid option as it explores the possibility of using a phone-service interpreting service to facilitate communication efficiently.
4. The nurse is educating a teenage female about preventing the transmission of genital herpes. Which of the following statements should the nurse include?
- A. "Do not sit on toilet seats without protection."?
- B. "Oral sex can transmit the virus."?
- C. "This infection can be transmitted via intercourse even when you do not feel ill."?
- D. "Try to drink plenty of fluids after sex to flush the reproductive tract."?
Correct answer: C
Rationale: Genital herpes can be transmitted through oral, genital, and anal sex. It is crucial to educate the patient that the infection can be transmitted via intercourse even when asymptomatic to prevent its spread. Choice A is incorrect as sitting on toilet seats without protection does not transmit genital herpes. Choice B is incorrect because oral sex can transmit the virus. Choice D is also incorrect as drinking fluids after sex does not prevent the transmission of genital herpes.
5. What is the most effective way to prevent skin breakdown?
- A. assistive devices
- B. repositioning
- C. topical medications
- D. avoiding tape and bandages
Correct answer: V
Rationale: Repositioning is the most effective way to prevent skin breakdown. Repositioning helps relieve pressure on specific areas of the skin, reducing the risk of developing pressure ulcers. While assistive devices (Choice A) may be beneficial in some cases, they are not universally as effective as repositioning. Topical medications (Choice C) are primarily used for treating skin conditions and are not the primary focus for preventing skin breakdown. Avoiding tape and bandages (Choice D) is crucial to prevent skin irritation, but repositioning remains the most effective method to prevent skin breakdown.
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