NCLEX-PN
NCLEX-PN Quizlet 2023
1. What is an appropriate intervention for the client with suspected genitourinary trauma and visible blood at the urethral meatus?
- A. Insertion of a Foley catheter.
- B. Performing an in-and-out catheter specimen for urinalysis.
- C. Obtaining a voided urine specimen for urinalysis.
- D. Ordering a urinalysis by the physician.
Correct answer: D
Rationale: When a client presents with suspected genitourinary trauma and visible blood at the urethral meatus, obtaining a voided urine specimen for urinalysis is an appropriate intervention. This helps assess for any urinary tract injuries or abnormalities without further traumatizing the area. Insertion of a Foley catheter (Choice A) should be avoided as it can worsen the existing trauma. Performing an in-and-out catheter specimen (Choice B) involves unnecessary manipulation and can increase the risk of complications. Ordering a urinalysis by the physician (Choice D) may delay the assessment compared to obtaining a direct voided urine specimen.
2. What is the best lab test to diagnose disseminated intravascular coagulation (DIC)?
- A. platelet count
- B. prothrombin time (PT)
- C. partial thromboplastin time (PTT)
- D. D-dimer
Correct answer: D
Rationale: The best lab test to diagnose disseminated intravascular coagulation (DIC) is the D-dimer test. In DIC, numerous small clots form throughout the body and are rapidly broken down. D-dimer measures a specific fibrin split product and is the most specific test for DIC. Platelet count (Choice A) is decreased in DIC due to consumption, but it is not specific for diagnosing DIC. Prothrombin time (PT - Choice B) and partial thromboplastin time (PTT - Choice C) are both elevated in DIC because clotting factors have been used up, but they are not specific for DIC as they can be elevated in other conditions as well.
3. How can light therapy be effective?
- A. Improving weight problems.
- B. Assisting with allergies.
- C. Using in alternative medical treatments.
- D. Working with sleep patterns.
Correct answer: D
Rationale: Light therapy can be effective in treating problems associated with sleep patterns, stress, moods, jaundice in newborns, and seasonal affective disorders. While light therapy may have other potential benefits, such as improving mood or helping with seasonal affective disorders, the main focus and effectiveness of light therapy are commonly linked to regulating sleep patterns. Therefore, the correct answer is 'Working with sleep patterns.' Choices A, B, and C are incorrect as light therapy is not primarily used for overcoming weight problems, helping with allergies, or solely as an alternative medical treatment.
4. When caring for a client with a possible diagnosis of placenta previa, which of the following admission procedures should the nurse omit?
- A. perineal shave
- B. enema
- C. urine specimen collection
- D. blood specimen collection
Correct answer: B
Rationale: The correct answer is 'enema.' Administering an enema to a client with placenta previa can dislodge the placenta, leading to an increased risk of bleeding and complications. It is crucial to avoid any interventions that may disrupt the placenta's positioning. Collecting urine and blood specimens are necessary for diagnostic purposes and monitoring, while a perineal shave is a routine procedure that does not pose a risk to the client with placenta previa.
5. The physician wants to know if a client is tolerating their total parenteral nutrition. Which of the following laboratory tests is likely to be ordered?
- A. triglyceride level
- B. liver function tests
- C. a glucose tolerance test
- D. a complete blood count
Correct answer: B
Rationale: The liver is crucial in processing nutrients and medications received through total parenteral nutrition. Liver function tests assess various enzymes produced by the liver, including prothrombin time/partial prothrombin time, serum glutamic oxaloacetic and pyruvic transaminases, gamma glutamyl transpeptidase, albumin, and alkaline phosphatase. Monitoring these enzymes can help determine if the liver is functioning properly to metabolize the nutrients from TPN. Triglyceride levels (Choice A) primarily evaluate the body's ability to clear fats, not specifically related to TPN tolerance. A glucose tolerance test (Choice C) is used to diagnose diabetes by measuring blood glucose levels after ingesting a glucose-rich solution, not directly related to TPN tolerance. A complete blood count (Choice D) assesses blood components such as red blood cells, white blood cells, and platelets but does not provide specific information about TPN tolerance.
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