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Safe and Effective Care Environment Nclex PN Questions

What should a client room environment include?

    A. a made bed, fresh water, thermostat regulation, and clean floors in all occupied client areas.

    B. a made bed, comfort and safety, a clutter-free area, hygiene articles nearby.

    C. accident prevention, comfort, a room (including furniture) that has been cleaned with chloroseptic wash, a bed that is made every other day.

    D. odor control (by spraying the room with deodorizers), closet storage of all client objects, a clean room. (Gloves should be worn when cleaning.)

Correct Answer: a made bed, comfort and safety, a clutter-free area, hygiene articles nearby.
Rationale: A client room environment should include a made bed to provide a sense of neatness and comfort, ensuring the client's safety at all times. It is important to maintain a clutter-free area to prevent accidents and promote a relaxing environment. Having hygiene articles nearby allows the client easy access to personal care items. Choice A is incorrect because while fresh water and thermostat regulation are important, they are not essential components of a client room environment. Choice C is incorrect as it emphasizes more on cleaning procedures rather than creating a comfortable and safe environment for the client. Choice D is incorrect as it emphasizes odor control and storage rather than the client's comfort and safety.

The client with a diagnosis of hepatitis is experiencing pruritus. Which would be the most appropriate nursing intervention?

  • A. Suggest that the client take warm showers once a day.
  • B. Add baby oil to the client’s bath water.
  • C. Apply powder to the client’s skin.
  • D. Suggest a cool-water rinse after bathing.

Correct Answer: Add baby oil to the client’s bath water.
Rationale: Pruritus, or itching, in clients with hepatitis can be alleviated by adding moisturizing agents to bath water. Baby oil helps soothe and moisturize the skin, reducing dryness and itching. Warm showers, as in choice A, can be drying to the skin if taken too frequently, making it less suitable than adding oil to the bath water. Applying powder, as mentioned in choice C, can exacerbate dryness rather than alleviate it. Choice D suggests a cool-water rinse after bathing, which can help in retaining moisture and is less drying compared to hot water rinses.

What is a true statement about post-discharge follow-up?

  • A. The nurse should ensure the client is educated on their discharge instructions.
  • B. If the client seems stable, they likely do not need a follow-up visit.
  • C. The physician is responsible for ensuring the client has their prescriptions upon discharge.
  • D. If the client has questions, the nurse should address them before discharge.

Correct Answer: A: The nurse should ensure the client is educated on their discharge instructions.
Rationale: The correct statement is that the nurse should ensure the client is educated on their discharge instructions. This is crucial to promote continuity of care and prevent adverse events. The responsibility of educating the client falls on the nurse, not assuming stability without a follow-up visit. While the physician may prescribe medications, it is the nurse's responsibility to ensure the client has them before discharge. Instructing the client to bring up questions at a follow-up appointment is not ideal; all questions should be addressed before discharge to ensure the client's understanding and compliance.

Which of the following is not one of the four categories related to client care plans?

  • A. privacy
  • B. evaluation
  • C. diagnosis
  • D. outcome

Correct Answer: privacy
Rationale: The four categories related to client care plans are diagnosis, intervention, outcome, and evaluation. Privacy is not typically considered a distinct category in client care plans, as it is more of a fundamental aspect that underlies all care provided to clients. Choices B, C, and D are directly related to the components of client care plans, making them incorrect answers in this context.

Which of the following clients would be most appropriate for an LPN to assign to a nursing assistant?

  • A. an 18-year-old client with a femur fracture who is just returning to the floor from the recovery unit
  • B. an 84-year-old client 2 days post-op after knee replacement surgery who needs help ambulating
  • C. a 35-year-old client who is suffering from an acute asthma attack
  • D. a 20-year-old client with Cystic Fibrosis who needs an early morning sputum sample collection

Correct Answer: a 20-year-old client with Cystic Fibrosis who needs an early morning sputum sample collection
Rationale: Collecting sputum samples on stable clients is within the scope of practice for an LPN. This task does not require immediate intervention or assessment by an RN or medical provider. An RN should perform the initial assessment on any client immediately post-op as it requires a higher level of assessment and monitoring. A client suffering from an acute asthma attack should be attended to by an RN or medical provider due to the potential severity and need for prompt intervention. Assigning a medically stable client who needs help ambulating to a nursing assistant is appropriate as it falls within their scope of practice and allows the LPN to focus on tasks that require their expertise.

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