NCLEX-RN
NCLEX RN Predictor Exam
1. What is the BEST blood collection location for a newborn?
- A. the AC
- B. the veins of the forehead
- C. the heel
- D. the fingertips
Correct answer: C
Rationale: When collecting blood from newborns, it is safest and most commonly done by collecting blood from the lateral or medial aspect of the baby's heel. This location is preferred due to the accessibility of the veins and the minimal discomfort caused to the newborn. Veins in the forehead are not commonly used for blood collection in newborns. The fingertips are not optimal for blood collection in newborns due to their small size and the potential for causing discomfort. The AC (antecubital) area, typically used in adults for blood collection, is not recommended for newborns due to the size of their veins and the potential risk of injury.
2. What is the primary route of transmission of MRSA?
- A. Shared needles
- B. Hands of healthcare workers
- C. Items in the healthcare environment
- D. Blood transfusions
Correct answer: B
Rationale: The correct answer is 'Hands of healthcare workers.' MRSA is primarily transmitted via the unwashed hands of healthcare workers who can carry the Staphylococcus aureus bacterium from one patient to another. Shared needles, items in the healthcare environment, and blood transfusions are not the main routes of transmission for MRSA. Shared needles can transmit bloodborne pathogens, items in the healthcare environment can harbor bacteria but are not the primary mode for MRSA, and blood transfusions are not a common route for MRSA transmission.
3. A client is complaining of pain that starts in the shoulder and travels down the length of his arm. This type of pain is referred to as:
- A. Referred pain
- B. Superficial pain
- C. Radiating pain
- D. Precipitating pain
Correct answer: C
Rationale: Radiating pain is the correct term for pain that originates in one part of the body and extends to other related areas. In this scenario, the pain starting in the shoulder and traveling down the arm describes radiating pain. Referred pain (Choice A) is pain felt at a site different from the actual origin of the pain. Superficial pain (Choice B) is pain that arises from the skin or tissues just beneath it. Precipitating pain (Choice D) refers to pain that is triggered by specific actions or events, not the characteristic described in the question.
4. In which of the following ways can a healthcare provider promote the sense of taste for an older adult?
- A. Mixing foods together on the dinner tray
- B. Avoiding cologne, air fresheners, or room deodorizers
- C. Encouraging the client to chew food thoroughly
- D. Discouraging the use of salt or seasonings with prepared food
Correct answer: C
Rationale: As individuals age, their sense of taste may diminish, impacting the enjoyment of eating. One effective way for a healthcare provider to promote the sense of taste for an older adult is by encouraging them to chew food thoroughly. Thorough chewing increases the contact of food with the taste buds, enhancing the chances of experiencing the flavors. Mixing foods together on the dinner tray may not necessarily enhance taste perception. Avoiding strong scents like cologne, air fresheners, or room deodorizers is more related to olfactory senses rather than taste. Discouraging the use of salt or seasonings can further diminish the taste experience for older adults who may already have reduced taste sensitivity.
5. The nurse is planning care for a patient with a wrist restraint. How often should a restraint be removed, the area massaged, and the joints moved through their full range?
- A. Once a shift
- B. Once an hour
- C. Every 2 hours
- D. Every 4 hours
Correct answer: C
Rationale: Restraints should be removed every 2 hours to prevent complications. Moving the joints through their full range of motion helps prevent muscle shortening and contractures. Massaging the area promotes circulation and reduces the risk of pressure injuries. Removing restraints less frequently could lead to complications like decreased circulation and skin breakdown. Options A, B, and D are incorrect because they do not align with the standard practice of removing restraints every 2 hours to ensure patient safety and well-being.
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