NCLEX-PN
Health Promotion and Maintenance NCLEX Questions
1. A new mother is being discharged from the maternity unit and provided with information about signs and symptoms to report to her health care provider. Which statement by the mother indicates a need for further information?
- A. ''I will call my nurse-midwife if I experience any redness, swelling, or tenderness in my legs.''
- B. ''My temperature needs to remain within a normal range.''
- C. ''Frequent urination and burning when I urinate are expected.''
- D. ''Feelings of pelvic fullness or pelvic pressure are a sign of a problem.''
Correct answer: C
Rationale: The correct answer is 'Frequent urination and burning when I urinate are expected.' This statement by the mother indicates a need for further information because these symptoms are not normal and could indicate a urinary tract infection or another issue that needs medical attention. The other choices correctly reflect signs and symptoms that should be reported to the health care provider. Redness, swelling, or tenderness in the legs can indicate a blood clot, and feelings of pelvic fullness or pressure can be signs of a problem. Monitoring temperature is also important to ensure there is no infection or other complications postpartum.
2. A nurse reviewing the physical assessment findings in a client's health care record notes documentation that the Phalen test caused numbness and burning. Which disorder does the nurse, on the basis of this finding, conclude that the client has?
- A. Scoliosis
- B. Bone deformity
- C. Heberden nodules
- D. Carpal tunnel syndrome
Correct answer: D
Rationale: The Phalen test is specifically used to assess for carpal tunnel syndrome. In this test, the client is asked to hold their hands back to back while flexing the wrists 90 degrees, which can reproduce the numbness and burning sensation experienced by individuals with carpal tunnel syndrome. Scoliosis is a condition characterized by abnormal lateral curvature of the spine, not related to the Phalen test. Bone deformity is a general term that does not specifically relate to the symptoms described. Heberden nodules are bony swellings that occur in osteoarthritis and are not assessed through the Phalen test.
3. An adult client undergoes various diagnostic tests to determine the pumping ability of the heart. The nurse notes that the results of these tests indicate that the client's cardiac output is 5 L/min. The nurse makes which conclusion?
- A. The client has a low cardiac output.
- B. The client has a high cardiac output.
- C. The client has a normal cardiac output.
- D. The client will need a blood transfusion.
Correct answer: C
Rationale: A cardiac output of 5 L/min falls within the normal range for a resting adult, which typically ranges between 4 and 6 L/min. Cardiac output is calculated as the stroke volume (volume of blood in each systole) multiplied by the heart rate. Therefore, a cardiac output of 5 L/min is considered normal. Choices A and B are incorrect as they misinterpret the result as either low or high, which is not the case based on the provided information. Choice D is unrelated to the client's cardiac output and thus incorrect.
4. An allergic reaction is classified as what type of pharmacological effect?
- A. a therapeutic effect
- B. a side effect
- C. an adverse effect
- D. an incompatibility
Correct answer: C
Rationale: An allergic reaction is classified as an adverse effect because it is an unintended response to a medication that requires treatment. A side effect is an undesired but somewhat expected reaction to a drug that does not necessarily need intervention. Incompatibility refers to an unsuitable combination of substances that leads to an adverse effect. A therapeutic effect is the desired and intended outcome of a medication.
5. Which of the following statements is correct about Maslow's hierarchy of needs?
- A. There are psychosocial interventions that may be applicable to all of the levels.
- B. There are physical interventions that may be applicable to all of the levels.
- C. Two of the levels may require physical intervention while four of the levels may require psychosocial intervention.
- D. Four of the levels may require physical intervention, while two of the levels may require psychosocial intervention.
Correct answer: C
Rationale: The correct statement about Maslow's hierarchy of needs is that two of the levels may require physical intervention while four of the levels may require psychosocial intervention. Maslow's theory suggests that physiological and safety needs are more basic and may require physical interventions, while social, esteem, and self-actualization needs are more psychosocial. Choices A and B are incorrect as they wrongly suggest that all levels may require only one type of intervention. Choice D is incorrect because it inaccurately represents the balance of physical and psychosocial interventions in Maslow's hierarchy of needs.
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