NCLEX-PN
Safe and Effective Care Environment Nclex PN Questions
1. A 45-year-old client with type I diabetes is in need of support services upon discharge from a skilled rehabilitation unit. Which of the following services is an example of a skilled support service?
- A. shopping for groceries
- B. house cleaning
- C. transportation to physician’s visits
- D. medication instruction
Correct answer: medication instruction
Rationale: The correct answer is 'medication instruction.' This service involves educating the client on how to properly take their medications, which requires a certain level of expertise and skill. Grocery shopping, house cleaning, and transportation to physician's visits are considered unskilled services as they do not involve specialized knowledge or training. In contrast, medication instruction is a skilled service that necessitates specific training to ensure the client's safety and adherence to their medication regimen.
2. A 4-year-old client is unable to go to sleep at night in the hospital. Which nursing intervention best promotes sleep for the child?
- A. turning off the room light and closing the door
- B. engaging the child in calming activities before bedtime
- C. identifying the child’s home bedtime rituals and following them
- D. encouraging relaxation techniques like deep breathing exercises
Correct answer: identifying the child’s home bedtime rituals and following them
Rationale: For a 4-year-old client struggling to sleep in the hospital, the best nursing intervention is to identify the child’s home bedtime rituals and follow them. Preschool-age children often have specific bedtime routines that provide comfort and promote sleep. This familiarity can help create a sense of security in an unfamiliar hospital environment. Choice A, turning off the room light and closing the door, may increase the child's fear of the dark and being alone. Choice B, engaging the child in calming activities before bedtime, is a better choice than tiring them with play exercises. Choice D, encouraging relaxation techniques like deep breathing exercises, although helpful, may not be as effective as following the child's familiar bedtime routines.
3. A nurse is reading the nurse practice act for the state in which she is employed. The nurse uses the information in this act for which purpose?
- A. To understand hospital and long-term care facility policies
- B. To know the scope of practice for nurses
- C. To identify health care policies in her state
- D. To be aware of the role of the licensed nurse
Correct answer: D
Rationale: The correct answer is 'To be aware of the role of the licensed nurse.' Nurse practice acts outline the scope of practice for nurses, defining what constitutes nursing practice and the role of licensed nurses. Choice A is incorrect because hospital and long-term care facility policies are institution-specific and not typically covered in the nurse practice act. Choice B is incorrect as the scope of practice for nurses is a part of the nurse practice act, but it's not the sole purpose for a nurse to refer to it. Choice C is incorrect as health care policies in a state are governed by other legislative acts, not the nurse practice act.
4. Which of the following statements by a client indicates adequate understanding of preparation for a lipoprotein fractionation test?
- A. “I cannot eat or drink after midnight.”
- B. “I cannot eat for 12 hours before the test.”
- C. “I need to limit my fluid intake.”
- D. “I need to ingest a lipid solution.”
Correct answer: “I cannot eat for 12 hours before the test.”
Rationale: The correct statement regarding preparation for a lipoprotein fractionation test is that the client cannot eat for 12 hours before the test. It is important to note that the client can drink an unrestricted amount of water. Limiting fluid intake is not necessary for this test. There is no need for the client to ingest a lipid solution as part of the preparation. Therefore, the other choices are incorrect.
5. Which of the following statements to the client’s family would be appropriate when preparing to provide postmortem care to the client?
- A. “You will not be allowed to see your family member after the postmortem care is performed.”
- B. “I am not able to assist you, but we can call pastoral care if you need any comfort.”
- C. “Unfortunately, we are not allowed to incorporate any cultural practices in my preparations.”
- D. “I will be ensuring that your family member is properly identified before they are transported.”
Correct answer: “I will be ensuring that your family member is properly identified before they are transported.”
Rationale: The correct statement when preparing to provide postmortem care to the client's family is to assure them that the family member will be properly identified before transportation. This is crucial in ensuring the correct individual is being handled respectfully. Choices A, B, and C are incorrect as they do not address the essential aspect of ensuring the proper identification of the deceased before transportation. It is important to allow the family to see their loved one after postmortem care and, if possible, incorporate any cultural practices. Providing comfort and support to the family during this difficult time is also essential in delivering holistic care.
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