NCLEX-RN
NCLEX RN Predictor Exam
1. The nurse is preparing to examine a 6-year-old child. Which action is most appropriate?
- A. The child is asked to undress from the waist up.
- B. The head is examined before the thorax, abdomen, and genitalia.
- C. The nurse should keep in mind that a child at this age will have a sense of modesty.
- D. Talking about the equipment being used is avoided to prevent increasing the child's anxiety.
Correct answer: C
Rationale: When examining a 6-year-old child, it is important to consider their sense of modesty. The child should undress themselves, leaving underpants on and using a gown or drape to maintain privacy. Additionally, a school-age child like a 6-year-old is curious about how equipment works, so it is beneficial to explain the purpose and function of the tools being used. The examination sequence should typically progress from the child's head to the toes to ensure a thorough assessment. Therefore, choices A, B, and D are incorrect as they do not align with the appropriate approach to examining a 6-year-old child.
2. A patient suffering from hyperglycemia would be experiencing:
- A. Low blood sugar
- B. High blood sugar
- C. Normal blood sugar
- D. None of the above
Correct answer: B
Rationale: Hyperglycemia is a condition characterized by high blood sugar levels. In this state, there is an excess of glucose in the bloodstream. Patients with hyperglycemia are often diagnosed with diabetes. The term 'hyperglycemia' specifically refers to elevated blood sugar levels. Therefore, the correct answer is 'High blood sugar.' Choices A, C, and D are incorrect because hyperglycemia indicates elevated blood sugar levels and not low or normal levels.
3. A second-year nursing student has just suffered a needlestick while working with a patient that is positive for AIDS. Which of the following is the most significant action that the nursing student should take?
- A. Immediately see a social worker
- B. Start prophylactic AZT treatment
- C. Start prophylactic Pentamidine treatment
- D. Seek counseling
Correct answer: B
Rationale: Starting prophylactic AZT treatment is the most critical intervention in this scenario. Azidothymidine (AZT) is an antiretroviral medication used to prevent and treat HIV/AIDS by reducing the replication of the virus. Post-exposure prophylaxis (PEP) for HIV involves taking medication to suppress the virus and prevent infection after exposure. PEP should be initiated within 72 hours of potential HIV exposure to be effective. Seeking treatment quickly is crucial to enhance its effectiveness. Seeing a social worker (Choice A) may be helpful for emotional support but is not the immediate priority. Pentamidine treatment (Choice C) is not indicated for post-exposure prophylaxis for HIV. Seeking counseling (Choice D) is important for the nursing student's emotional well-being but does not address the urgent need for post-exposure prophylaxis to prevent HIV transmission.
4. What is the most useful patient position for proctologic exams?
- A. Trendelenburg
- B. Semi-Fowler's
- C. Full Fowler's
- D. Jack Knife
Correct answer: D
Rationale: The Jack Knife position is the most useful for proctologic exams as it allows the patient to lie face down while keeping the buttocks elevated, providing optimal access for the examination. The Trendelenburg position, characterized by the body being laid flat with the feet higher than the head, is not suitable for proctologic exams. Semi-Fowler's and Full Fowler's positions are typically utilized for respiratory or cardiovascular conditions and are not ideal for proctologic examinations due to their lack of optimal access to the perianal area.
5. What is the minimum amount of personal protective equipment for a nurse when working with a newborn immediately after a high-risk delivery in a client's room?
- A. Sterile gown, gloves
- B. Mask, gown, shoe covers
- C. Gloves
- D. Hat, mask, gloves, gown, shoe covers
Correct answer: C
Rationale: The correct answer is gloves. When attending a high-risk delivery and handling a newborn immediately after birth, the minimum personal protective equipment required for a nurse includes gloves. This is essential to protect the nurse from potential exposure to the mother's blood or body fluids that may be present on the newborn's skin. Choices A, B, and D include additional protective equipment that is not necessary for this specific scenario. Wearing gloves is crucial for infection control and to prevent the transmission of pathogens.
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