NCLEX-PN
Health Promotion and Maintenance NCLEX Questions
1. A rubella titer is performed on a pregnant client, and the results indicate a titer of less than 1:8. The nurse provides the client with which information?
- A. She must have been exposed to the rubella virus at some point in her life.
- B. The test will need to be repeated during the pregnancy.
- C. She has not developed immunity to the rubella virus.
- D. The test results are normal.
Correct answer: B
Rationale: A rubella titer of less than 1:8 indicates that the client is not immune to rubella. In such cases, retesting will be necessary during the pregnancy. If the client is found to be non-immune, rubella immunization is required post-delivery. Therefore, choices A, C, and D are incorrect. Choice A suggests exposure, which cannot be confirmed by the titer result. Choice C wrongly implies that the client has not developed immunity, which is not accurate. Choice D is incorrect as the titer result is not within the normal immune range.
2. What is the primary force in sex education in a child's life?
- A. school nurse
- B. peers
- C. parents
- D. media
Correct answer: C
Rationale: Parents are the primary force in sex education in a child's life. Parents play a central role in shaping a child's understanding of sex from an early age. They provide continuous guidance, values, and information about sex and relationships. While the school nurse is involved in formal sex education and counseling within the school setting, parents have the most direct and significant impact on a child's sex education. Peers become more influential during adolescence, but their information may not always be accurate or appropriate. The media also exert significant influence on children's perceptions of sex through various forms of entertainment like movies, TV shows, and video games, but parents remain the primary educators on this subject.
3. What type of immunity do vaccines provide?
- A. active
- B. passive
- C. transplacental
- D. active and passive
Correct answer: A
Rationale: Vaccines provide active immunity by stimulating the immune system to produce antibodies against specific pathogens. Choice B, passive immunity, is acquired from ready-made antibodies, not through vaccination. Choice C, transplacental immunity, is a form of passive immunity transferred from mother to infant, not acquired through vaccines. Therefore, the correct answer is active immunity.
4. Which of the following actions should the LPN perform for a client with an active digoxin IV order? Select all that apply.
- A. plug the patient to the ECG Monitor
- B. Administer the medication over at least 5 minutes.
- C. Monitor respirations during administration.
- D. Monitor the client's pulse for 1 minute prior to administration.
Correct answer: D
Rationale: The correct actions for the LPN to perform for a client with an active digoxin IV order are to monitor ECG rhythm throughout administration and monitor the client's pulse for 1 minute prior to administration. These actions are crucial as digoxin affects the heart's electrical activity, and it should not be administered if the client's pulse is less than 60 bpm. Monitoring respirations and blood pressure are not directly associated with digoxin administration. Administering IV medications is typically outside the LPN's scope of practice.
5. The parents of a 2-year-old child ask the nurse how they can teach their child to stop taking toys away from other children. Which of the following statements by the nurse offers the parents the best explanation of their child's behavior?
- A. "Your child is egocentric. Egocentricity is normal for 2-year-old children. He believes other children want him to have their toys."?
- B. "Your child is showing negativity. He doesn't want other children to have the toys he wants."?
- C. "Your child is demonstrating magical thinking. He believes he can make the other children want him to play with their toys."?
- D. "Your child is engaging in domestic imitation. He is doing what he has seen other children do."?
Correct answer: A
Rationale: Two-year-old children are very egocentric, believing everything revolves around them. They think other children want them to have their toys, which explains why they may take toys from others. This behavior is typical for children at this age as they lack the ability to see things from another's perspective. Option B is incorrect because negativity in children this age is more related to refusal of requests rather than taking toys. Magical thinking, as described in option C, is usually seen in preschool-age children and involves unrealistic beliefs. Option D is incorrect as domestic imitation refers to imitating adult household tasks, not other children's behavior.
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