NCLEX NCLEX-PN
NCLEX PN Test Bank
1. When planning task assignments for five clients on the skilled nursing unit in a long-term care facility, which task should a licensed practical nurse (LPN) assign to another LPN?
- A. Bathing a client who is confused and requires assistance with a shower
- B. Administering regular insulin in accordance with a sliding-dosage scale every 4 hours to a client with diabetes mellitus
- C. Assisting a client requiring a bed bath and frequent ambulation with a cane
- D. Transporting a client who must be accompanied to physical therapy twice during the shift
Correct answer: Administering regular insulin in accordance with a sliding-dosage scale every 4 hours to a client with diabetes mellitus
Rationale: When assigning tasks, the nurse must consider the skills and educational level of the nursing staff. The nursing assistant may be assigned tasks like caring for a confused client, assisting with a shower or a bed bath, ambulating a client with a cane, and accompanying a client to physical therapy. The LPN is educated to administer medications like regular insulin in accordance with a sliding scale. This task requires a higher level of training and knowledge than the tasks that can be delegated to a nursing assistant. Administering insulin involves assessing blood glucose levels, calculating dosages, and understanding the effects of insulin therapy on the client's condition. Therefore, the correct answer is administering regular insulin to a client with diabetes mellitus. Choices A, C, and D involve tasks that are within the scope of practice of a nursing assistant, not an LPN.
2. In which age group does the highest incidence of child abuse occur?
- A. Birth–3 years old
- B. 4–6 years old
- C. 6–10 years old
- D. More than 10 years old
Correct answer: Birth–3 years old
Rationale: The correct answer is 'Birth–3 years old.' Children between birth and 3 years of age have the highest rates of victimization (at 16 per 1,000 children). This age group is most vulnerable due to their dependency and inability to report or protect themselves effectively. Child abuse can occur at any age, but statistics show that infants and toddlers are at the highest risk due to their developmental stage and reliance on caregivers. Choices B, C, and D are incorrect because while child abuse can happen at any age, the prevalence is highest among children in the 0-3 age group.
3. Which of the following statements by a client indicates adequate preparation for magnetic resonance imaging?
- A. “I should wear earplugs during the test.”
- B. “I should remove my metal jewelry before the test.”
- C. “I should inform the healthcare provider about my pacemaker.”
- D. “I should inform the healthcare provider about my artificial hip.”
Correct answer: “I should wear earplugs during the test.”
Rationale: The correct statement is, '“I should wear earplugs during the test,”' as MRI scanners produce loud noises requiring ear protection. Metal objects, including jewelry, are not allowed inside the MRI room due to safety concerns related to the magnetic field. Choices B, C, and D are incorrect. Choice B is wrong because metal objects, including jewelry, are not permitted in the MRI room. Choices C and D are incorrect as having a pacemaker or an artificial hip raises concerns due to the magnetic field in MRI, requiring special precautions or considerations. It is crucial for individuals with such implants to inform their healthcare provider to assess the risks and determine the appropriate course of action.
4. During a well-baby check of a 6-month-old infant, the nurse notes abrasions and petechiae of the palate. The nurse should:
- A. inquire about the possibility of sexual abuse.
- B. ask about the types of foods the child is eating.
- C. request to see the type of bottle used for feedings.
- D. question the parent about objects the child plays with.
Correct answer: inquire about the possibility of sexual abuse.
Rationale: The correct answer is to inquire about the possibility of sexual abuse. Injuries to the soft palate such as bruising, abrasions, and petechiae can be signs of sexual abuse in infants. While oral sex may not leave significant physical evidence, these findings should raise suspicion. Option A is correct as it focuses on addressing potential abuse. Options B, C, and D are incorrect because the child's diet, the type of bottle used for feedings, and play objects are not likely related to the observed injuries. The presence of oral injuries suggests considering sexual abuse rather than other factors.
5. Which of the following is true of advanced directives?
- A. They should be appropriately documented in the client’s chart.
- B. They are only applicable if the client has a terminal illness.
- C. They are required if the client is unconscious.
- D. They are non-legal requests.
Correct answer: They should be appropriately documented in the client’s chart.
Rationale: The correct answer is that advanced directives should be appropriately documented in the client’s chart. Advanced directives are legal requests regarding a client’s healthcare that come into effect under specific circumstances, regardless of the severity of their illness or level of consciousness. Choice B is incorrect because advanced directives can cover various healthcare decisions, not just terminal illnesses. Choice C is incorrect as advanced directives can be established and documented while the client is conscious, not only if they are unconscious. Choice D is incorrect because advanced directives are indeed legal requests, not non-legal requests.
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