NCLEX-PN
Health Promotion and Maintenance NCLEX PN Questions
1. When performing an eye examination, which area can a healthcare provider best visualize using an ophthalmoscope?
- A. Iris
- B. Cornea
- C. Optic disc
- D. Conjunctiva
Correct answer: C
Rationale: An ophthalmoscope is a tool used to visualize the internal structures of the eye during an examination. The optic disc, located on the internal surface of the retina, can be best visualized using an ophthalmoscope. The iris, cornea, and conjunctiva are superficial structures that can be examined without the need for an ophthalmoscope. Therefore, the correct answer is the optic disc. Choices A, B, and D are incorrect because they are external structures that can be examined directly without the use of an ophthalmoscope.
2. A laboring client is experiencing late decelerations. Which position should she be placed in?
- A. left lateral
- B. lithotomy
- C. semi-Fowler's
- D. right lateral
Correct answer: A
Rationale: The correct answer is the left lateral position. Placing the laboring client in the left lateral position is beneficial because it promotes blood flow to the placenta. Late decelerations indicate potential issues with fetal oxygenation, and changing the position to left lateral can help improve placental perfusion. Choices B, C, and D are incorrect because lithotomy, semi-Fowler's, and right lateral positions do not specifically address the need for improved blood flow to the placenta in cases of late decelerations.
3. When a 16-year-old girl visits the women's health clinic to obtain information about birth control because she is sexually active and wants to avoid pregnancy, what should the nurse do first when interviewing the client?
- A. Assess the client's knowledge of available birth control methods.
- B. Inform the client that birth control methods can be discussed without the client's boyfriend present.
- C. Tell the client that for her age and lifestyle, birth control pills would be one of the methods of contraception.
- D. Give the client written material about various birth control methods and ask her to read them and to call if she has any questions.
Correct answer: A
Rationale: When a client seeks information about birth control, it is essential for the nurse to first assess the client's existing knowledge on the subject. This enables the nurse to provide tailored information that complements what the client already knows, facilitating better understanding and decision-making. Providing written material is a helpful educational tool but should not be the first intervention. Offering specific advice on birth control methods based on age and lifestyle limits the client's autonomy and decision-making process. Mentioning the client's boyfriend as a requirement for discussing birth control is inappropriate and nontherapeutic, as the client should be able to seek information independently.
4. A nurse is preparing to auscultate a client's breath sounds. To assess vesicular breath sounds, the nurse places the stethoscope over which area?
- A. Major bronchi
- B. The xiphoid process
- C. The trachea and larynx
- D. The peripheral lung fields
Correct answer: D
Rationale: To assess vesicular breath sounds, the nurse should place the stethoscope over the peripheral lung fields. Vesicular breath sounds are heard in these areas where air flows through the smaller bronchioles and alveoli. Bronchovesicular breath sounds, not vesicular, are heard over the major bronchi. Bronchial (tracheal) breath sounds are heard over the trachea and larynx, not vesicular sounds. Breath sounds are not heard over the xiphoid process, making it an incorrect choice.
5. After undergoing gastric resection, which of the following meals is most likely to cause rapid emptying of the stomach?
- A. a high-protein meal
- B. a high-fat meal
- C. a large meal regardless of nutrient content
- D. a high-carbohydrate meal
Correct answer: D
Rationale: After gastric resection, meals high in carbohydrates are more likely to cause rapid emptying of the stomach. Carbohydrates stimulate the release of gastrin, which accelerates gastric emptying. In contrast, high-fat and high-protein meals tend to delay gastric emptying. While a large meal can slow down gastric emptying, the specific nutrient content, such as high carbohydrates, plays a significant role in promoting rapid emptying. Therefore, a high-carbohydrate meal is the correct choice as it is most likely to lead to rapid gastric emptying compared to the other options.
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