NCLEX-PN TEST BANK

Safe and Effective Care Environment Nclex PN Questions

Which of these should not be included when calculating a client’s fluid intake?

    A. ice chips

    B. Jell-O™

    C. pudding

    D. IV fluid from an antibiotic piggyback

Correct Answer: pudding
Rationale: Pudding is a semi-solid and does not contribute significantly to fluid intake as it does not melt at room temperature. Therefore, it should not be included in fluid intake calculations. On the other hand, ice chips, Jell-O™, and IV fluid from an antibiotic piggyback are all sources of fluid that can significantly contribute to a client's total fluid intake and should be considered when calculating it. Ice chips and Jell-O™ provide hydration upon melting, while IV fluid directly adds to the fluid volume in the body.

A client being treated for sickle cell disease has an order for pain medication. Morphine was ordered, but the nurse is having difficulty deciphering the dose. The nurse should ____.

  • A. ask the attending physician to clarify the order, including the correct medication, dose, route, and frequency
  • B. call the charge nurse to inform the attending physician and verify the order, including the correct medication, dose, route, and frequency
  • C. call the attending physician to verbally verify the order, including the correct medication, dose, route, and frequency
  • D. refrain from administering the medication until the charge nurse can assist in determining the correct dosage

Correct Answer: call the attending physician to verbally verify the order, including the correct medication, dose, route, and frequency
Rationale: In this scenario, when a nurse encounters difficulties in deciphering an order, the appropriate action is to contact the attending physician directly to clarify and verify the medication, dose, route, and frequency. It is crucial for the nurse to have a clear understanding of the order before administering any medication to ensure patient safety and proper treatment. Option A is incorrect as it suggests asking the attending physician to clarify without specifying the urgency of the situation. Option B involves an unnecessary additional step by first contacting the charge nurse before reaching out to the attending physician, potentially delaying the clarification process. Option D is incorrect as it advises refraining from administering the medication, which may not be necessary if the correct dosage can be promptly verified by contacting the attending physician.

An LPN is having a conflict with another nurse during her shift. She has tried to discuss the issues with the nurse with no resolution. What is the most appropriate way for the LPN to proceed?

  • A. Report the conflict to the director of nursing over the unit.
  • B. Report the conflict to the assigned charge nurse of the unit.
  • C. Report the conflict to the nurse manager of the unit.
  • D. Discuss the conflict with the other nurse to attempt resolution of the issue.

Correct Answer: Report the conflict to the assigned charge nurse of the unit.
Rationale: In this scenario, the most appropriate way for the LPN to proceed is to report the conflict to the assigned charge nurse of the unit. Following the chain of command is crucial in a professional setting to address conflicts effectively. Reporting the issue to the charge nurse, who is the immediate supervisor, allows for a structured approach to resolving the conflict. Reporting directly to higher levels such as the director of nursing or nurse manager may bypass the appropriate hierarchy and could create unnecessary tension. Attempting to resolve the issue independently with the other nurse may not be effective if previous attempts have failed, making it essential to involve the immediate supervisor.

The nurse is teaching a client about erythema infectiosum. Which of the following factors is not correct?

  • A. There is no rash.
  • B. The disorder is uncommon in adults.
  • C. There is no fever.
  • D. There is sometimes a 'slapped face' appearance.

Correct Answer: The disorder is uncommon in adults.
Rationale: The correct answer is B: 'The disorder is uncommon in adults.' Erythema infectiosum, also known as Fifth's disease, is more common in children than in adults. It typically presents with a rash on the face that gives a 'slapped cheek' or 'slapped face' appearance. Fever may be present, and there is a characteristic rash associated with the condition. Therefore, the statement 'The disorder is uncommon in adults' is incorrect, making it the correct answer. The other statements are true regarding erythema infectiosum, making them incorrect choices. There is indeed a rash associated with erythema infectiosum, which can be a prominent feature. Fever may also be present in individuals with this condition. Additionally, the 'slapped face' appearance is a classic characteristic of erythema infectiosum.

Which isolation procedure will be followed for secretions and blood?

  • A. Respiratory Isolation
  • B. Standard Precautions
  • C. Contact Isolation
  • D. Droplet Isolation

Correct Answer: Standard Precautions
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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