NCLEX-RN
NCLEX RN Predictor Exam
1. A client who complains of nausea and seems anxious is admitted to the nursing unit. The nurse should take which of the following actions regarding completion of the admission interview?
- A. Help the client to get settled and conduct the interview the next morning when the client is rested
- B. Conduct the interview immediately, directing the majority of the questions to the client
- C. Conduct the interview as soon as uninterrupted time is available to address the client's concerns
- D. Ask the charge nurse to interview the client while the admitting nurse calls the doctor for anti-nausea and anti-anxiety medication
Correct answer: C
Rationale: When dealing with a client who is experiencing nausea and anxiety, it is important to promptly conduct the admission interview to address their concerns. This allows for the collection of accurate data while attending to the client's immediate needs. Delaying the interview until the next morning (Choice A) may not be in the best interest of the client as timely assessment and intervention are essential. Directing questions to the client's spouse (Choice B) may not provide accurate information from the client themselves. Asking another nurse to conduct the interview while administering medications (Choice D) does not prioritize building a therapeutic relationship with the client, which is crucial in addressing their concerns and providing holistic care.
2. Which principle of body mechanics may help to reduce the risk of a back injury?
- A. Maintain a wide base of support
- B. Bend from the knees, not the waist
- C. Keep the back straight while lifting
- D. Push or pull objects rather than lifting
Correct answer: C
Rationale: Proper body mechanics are crucial to prevent injuries, especially for professions involving lifting and moving objects. Keeping the back straight while lifting is essential to reduce the risk of back injuries as it helps maintain the spine's natural alignment and prevents excessive strain on the back muscles. Choosing choices A, B, and D would increase the risk of back injury. Maintaining a wide base of support provides stability, bending from the knees instead of the waist protects the lower back, and pushing or pulling objects reduces the strain on the back muscles, all contributing to preventing back injuries.
3. The nurse is caring for a patient who has a right-sided chest tube after a right lower lobectomy. Which nursing action can the nurse delegate to the unlicensed assistive personnel (UAP)?
- A. Document the amount of drainage every eight hours
- B. Obtain samples of drainage for culture from the system
- C. Assess patient pain level associated with the chest tube
- D. Check the water-seal chamber for the correct fluid level
Correct answer: A
Rationale: The correct answer is to document the amount of drainage every eight hours. UAP education typically includes tasks related to documentation of intake and output. Obtaining samples of drainage for culture and assessing patient pain level are nursing responsibilities that require licensed nursing personnel's education and scope of practice. Checking the water-seal chamber for the correct fluid level also falls under the nursing role, as it involves monitoring and maintaining the chest tube system, which requires nursing knowledge and training.
4. What is the purpose of MSDS sheets?
- A. Contain the ordering information for each piece of equipment in the office.
- B. Are required by OSHA to be accessible to all employees of the office.
- C. Can be used to treat patients who have been injured in equipment accidents.
- D. None of the above.
Correct answer: B
Rationale: MSDS sheets, also known as Materials Safety Data Sheets, are essential documents that provide detailed information about chemicals used in the workplace. They are required by OSHA to be easily accessible to all employees to ensure they have the necessary information to handle chemicals safely. MSDS sheets do not contain ordering information for equipment in the office (Choice A) or serve as a treatment guide for injured patients (Choice C). Therefore, the correct answer is that MSDS sheets are required by OSHA to be accessible to all employees of the office.
5. When measuring a patient's body temperature, what factor should be considered that can influence the temperature?
- A. Constipation
- B. Diurnal cycle
- C. Nocturnal cycle
- D. Patient's emotional state
Correct answer: B
Rationale: When measuring body temperature, it is essential to consider factors that can influence it. The diurnal cycle, which refers to the body's natural temperature variations throughout a 24-hour period, can impact body temperature readings. Factors like exercise, age, and environment can also affect body temperature. Constipation does not directly influence body temperature. The 'nocturnal cycle' is not a recognized term in relation to body temperature. While a patient's emotional state can affect vital signs, it is not a primary factor in influencing body temperature measurements.
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