NCLEX-PN
Safe and Effective Care Environment Nclex PN Questions
1. Which of the following statements from a client may indicate that they are at a higher risk for a fall?
- A. "I would like to get out of bed but would like to put on my non-skid socks first."?
- B. "Can you make sure the two bedrails are raised before leaving the room?"?
- C. "I think I'm ready to walk a longer distance with the cane today."?
- D. "I need to get out of bed to go to the bathroom now. I cannot find my glasses but cannot wait."?
Correct answer: D
Rationale: The correct answer is 'I need to get out of bed to go to the bathroom now. I cannot find my glasses but cannot wait.' This statement indicates that the client is in a hurry and unable to find their glasses, which could increase the risk of a fall due to impaired vision. Choice A about putting on non-skid socks shows the client's awareness of fall prevention, reducing the risk. Choice B demonstrates the client's request for bedrails to be raised, which is a safety measure, reducing the risk as well. Choice C suggests the client's readiness to walk a longer distance with a cane, indicating progress in mobility but not necessarily a higher fall risk.
2. The nurse belongs to a professional nursing organization that provides social, educational, and political venues for nurses. The nurse has been active in this organization for almost two years, during which time she meets and works with nurses from several different nursing agencies and health care institutions to achieve a variety of goals, including obtaining advice regarding a personal career choice. This is an example of:
- A. professional nurturing.
- B. networking.
- C. mentoring.
- D. collegiality.
Correct answer: B
Rationale: Networking involves the process of developing and using contacts throughout one's professional career for information, advice, and support. In this scenario, the nurse is actively engaging with other professionals from various institutions to achieve common goals and seek career advice, which aligns with the concept of networking. Professional nurturing and mentoring focus on providing support and guidance to colleagues, while collegiality refers to the camaraderie and rapport established among individuals through shared experiences, which is not the primary focus of the nurse's interaction in the given situation.
3. 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.
4. Several passengers aboard an airliner suddenly become weak and suffer breathing difficulty. The diagnosis is likely to be:
- A. Outbreak of Asian flu.
- B. Chemical exposure.
- C. Bacterial pneumonia.
- D. Allergic reaction.
Correct answer: B
Rationale: The most likely cause of groups of individuals suddenly experiencing similar signs of illness all at once is a chemical exposure. In this scenario, considering the sudden onset of symptoms in multiple passengers on an airliner, the symptoms are more indicative of a chemical exposure rather than Asian flu, bacterial pneumonia, or an allergic reaction. Asian flu, bacterial pneumonia, and allergic reactions do not typically manifest in a way that would affect a group of individuals simultaneously. Therefore, the correct diagnosis in this case is likely to be a chemical exposure.
5. Delegation of tasks to appropriate personnel allows the nurse to:
- A. ensure tasks are appropriately distributed.
- B. keep other members of the team productive.
- C. maintain tight control of all aspects of the workflow.
- D. recognize the importance of team members' roles.
Correct answer: B
Rationale: Delegating tasks to appropriate personnel is essential for a nurse to keep other team members productive. By assigning tasks that align with the specific roles and responsibilities of team members, the nurse can enhance work effectiveness and efficiency. Option A is incorrect because delegation is not primarily about ensuring tasks are evenly distributed but rather about utilizing team members' skills effectively. Option C is incorrect as maintaining tight control of all aspects of the workflow can hinder teamwork and limit individual growth. Option D is incorrect because effective delegation involves empowering team members to make decisions within their scope of practice, rather than solely recognizing the importance of their roles.
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