NCLEX-PN
Nclex Questions Management of Care
1. The nurse is transferring a client from a wheelchair to the bed. Which is the correct procedure?
- A. Pull the client toward you, and pivot him on the unaffected limb.
- B. Pull the client toward you, and pivot him on the affected limb.
- C. Push the client toward the bed, and pivot him on the affected limb.
- D. Stand the client on both legs, and push him toward the bed.
Correct answer: A
Rationale: When transferring a client from a wheelchair to the bed, the correct procedure is to pull the client toward you, which reduces workload force. By pivoting the client on the unaffected limb, strength is maintained to support the affected limb while moving towards the bed. Choice A is correct because it ensures a safe and effective transfer technique. Choices B, C, and D are incorrect as they involve incorrect positioning and movements that could potentially harm the client or increase the risk of injury. Pulling the client towards you puts less strain on your back and reduces the risk of injury. Pivoting on the unaffected limb ensures better support for the client's affected limb during the transfer process.
2. The nurse acts as an advocate for the nursing profession by performing all of the following activities except:
- A. encouraging political involvement by nurses with their legislators.
- B. acting as a first-aid provider for a children's athletic team.
- C. precepting newly licensed nurses in the work situation.
- D. encouraging as many persons to become nurses as possible.
Correct answer: D
Rationale: The nurse acts as an advocate for the nursing profession by encouraging appropriate persons to become nurses, by being a positive role model and mentor, and by communicating the needs of nurses in the most professional manner possible to those making the laws. Encouraging as many persons as possible to become nurses may not align with the advocacy role, as the focus should be on quality rather than quantity. Choices A, B, and C are activities that align with being an advocate for the nursing profession by promoting political involvement, providing first aid, and precepting newly licensed nurses, respectively.
3. In an obstetrical emergency, which of the following actions should the nurse perform first after the baby delivers?
- A. Place extra padding under the mother to absorb blood from the delivery.
- B. Cut the umbilical cord using sterile scissors.
- C. Suction the baby's mouth and nose.
- D. Wrap the baby in a clean blanket to preserve warmth.
Correct answer: C
Rationale: In an obstetrical emergency, the immediate priority after the baby delivers is to clear the baby's airway by suctioning the mouth and nose to ensure effective breathing. This action helps prevent potential complications like meconium aspiration. Cutting the umbilical cord, wrapping the baby in a blanket, or placing extra padding under the mother can follow once the baby's airway is clear. Therefore, suctioning the baby's mouth and nose is the most critical and time-sensitive intervention in this scenario. Placing extra padding under the mother is not the immediate priority as ensuring the baby's airway is clear. Cutting the umbilical cord and wrapping the baby in a clean blanket are important but can wait until after ensuring the baby's breathing is not compromised.
4. Which hormone in the urine is specifically indicative of pregnancy?
- A. estrogen
- B. progesterone
- C. testosterone
- D. human chorionic gonadotropin
Correct answer: D
Rationale: Human chorionic gonadotropin is the hormone specifically indicative of pregnancy as it is produced by the placenta after implantation. It can be detected in urine and blood samples to confirm pregnancy. Estrogen and progesterone play crucial roles in the menstrual cycle and pregnancy but are not specific indicators of pregnancy on their own. Testosterone is a hormone primarily associated with male reproductive functions and is not directly related to pregnancy, making it an incorrect choice in this context.
5. Which isolation procedure will be followed for secretions and blood?
- A. Respiratory Isolation
- B. Standard Precautions
- C. Contact Isolation
- D. Droplet Isolation
Correct answer: B
Rationale: The correct answer is Standard Precautions. Standard precautions are taken in all situations for all clients and involve all body secretions except sweat. They are designed to reduce the rate of transmission of microbes from one host to another or one source to another. Respiratory Isolation (Choice A) is used for diseases transmitted by airborne particles, not secretions and blood. Contact Isolation (Choice C) is for clients known or suspected to be infected with microorganisms that can be transmitted by direct or indirect contact. Droplet Isolation (Choice D) is used for diseases transmitted by large respiratory droplets expelled during coughing, sneezing, talking, or procedures.
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