NCLEX-PN
Nclex PN Questions and Answers
1. During an emergency procedure, is the surgical timeout a requirement?
- A. The surgical timeout should be performed by the surgical team unless it would cause a delay leading to injury or death.
- B. No, the timeout is not necessary during an emergency procedure.
- C. No, the surgical timeout is not required in emergency procedures.
- D. Yes, the surgical timeout must be performed in all cases.
Correct answer: A
Rationale: During an emergency procedure, the surgical timeout should be performed unless doing so would cause a delay leading to injury or death. This is because the primary goal during an emergency is to swiftly address the critical situation. Choice B is incorrect as it implies that the timeout is not necessary, which is not accurate. Choice C is also incorrect as it suggests that the timeout is not required in emergency procedures, disregarding safety protocols. Choice D is incorrect as it wrongly states that the timeout must be performed in all cases without considering the potential risks associated with delays during emergencies.
2. A test that can correctly identify those who do not have a given disease is:
- A. specific.
- B. sensitive.
- C. negative culture.
- D. marginal finding.
Correct answer: A
Rationale: The correct answer is 'specific.' A specific test correctly identifies individuals who do not have a particular disease. In this case, since the lab culture report is negative for the suspected infection, it means the test is good at ruling out the disease. 'Sensitive' (choice B) would be incorrect as sensitivity refers to a test's ability to correctly identify individuals who do have the disease. 'Negative culture' (choice C) is incorrect as it describes the result rather than the test's characteristic. 'Marginal finding' (choice D) is unrelated to the concept of correctly identifying individuals without the disease.
3. A nurse in a long-term care center notes that an employee is constantly calling in sick. Which action should the nurse take initially to handle this problem?
- A. Documenting the employee's absences in the personnel file
- B. Discussing the situation with the employee and reminding them of the agency's employment standards
- C. Reporting the employee to administration
- D. Issuing a written warning to the employee
Correct answer: B
Rationale: When an employee demonstrates excessive absenteeism, the initial action a nurse should take is to discuss the situation with the employee and remind them of the agency's employment standards. It is important to communicate openly with the employee to understand the reasons for their frequent absences and remind them of the expectations regarding attendance. This approach allows for a constructive dialogue and provides the employee with an opportunity to rectify their behavior. Documenting the employee's absences in the personnel file may be necessary if the issue persists despite the discussion. Reporting the employee to administration should be considered only if the employee fails to improve after the initial discussion. Issuing a written warning should be a subsequent step if the employee continues to violate the attendance policies even after reminders and discussions.
4. When assessing a client's risk for elimination impairment, which of the following factors is least relevant?
- A. current medications
- B. ambulation abilities
- C. family history
- D. hydration status
Correct answer: C
Rationale: When assessing a client's risk for elimination impairment, family history is the least relevant factor to consider. Current medications can affect elimination functions through side effects, ambulation abilities can impact mobility to access toileting facilities, and hydration status directly influences urinary output and bowel function. Family history, although providing some context, does not have a direct impact on the client's current risk of elimination impairment.
5. All of the following interventions should be performed when fetal heart monitoring indicates fetal distress except:
- A. increase maternal fluids
- B. administer oxygen
- C. decrease maternal fluids
- D. turn the mother
Correct answer: C
Rationale: When fetal distress is indicated, interventions are aimed at improving oxygenation and blood flow to the fetus. Increasing maternal fluids helps improve blood flow and oxygen delivery, administering oxygen increases oxygenation levels, and turning the mother can help optimize fetal oxygenation. Decreasing maternal fluids would negatively impact blood volume and can worsen fetal distress, making it the exception among the listed interventions. Therefore, decreasing maternal fluids should not be performed when fetal distress is present.
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