NCSBN TEST BANK FOR THE
NCLEX RN (NGN) 2023/2024
VERIFIED 200 QUESTIONS and
Answers with Rationale
A nurse is teaching a mother who will breast-feed for the first time.
Which of these approaches is a priority?
Give the mother privacy for the initial feeding
Assist the mother to position the newborn at the breast
Give the mother several illustrated pamphlets
Show the mother films on the physiology of lactation -
>>ANSWER>>Assist the mother to position the newborn at the breast
All of the approaches should be helpful in teaching. However, the
priority is to place the infant to the breast as soon after birth as
possible to establish contact and allow the newborn to begin to suck.
,The nurse in a long-term care facility is evaluating the plan of care for
an older adult client with advanced dementia. The client has had
several falls out of bed. Which initial intervention should the nurse
implement?
Have the client sleep in a recliner at the nurse's station with a tray
table across their lap
Put the bed in the lowest position with a thick pad or mat on the
floor next to the bed
Correct!
Place the client in a bed with an enclosure mesh tent attached to the
frame
Position all side rails of the bed up and move the bed close to the
door - >>ANSWER>>Falls out of bed are a common occurrence in the
long-term care setting. Although it is nearly impossible to eliminate
all falls, the nurse can implement interventions to reduce the risk for
injury related to a fall. The goal is to start with the least invasive and
restrictive intervention to preserve the client's rights, regardless of
their level of cognitive function. 'Low' beds and 'landing' mats to
soften the fall should the client roll out of bed are commonly used in
long-term care settings and represent an appropriate, initial
intervention to implement for this client. The other interventions are
much more restrictive and should be used only after less restrictive
interventions have been attempted.
,The nurse is developing a plan of care for a client who underwent
total hip arthroplasty 24 hours ago. Which interventions should the
nurse include? Select all that apply.
1. Encourage the client to perform leg exercises while in bed
2. Remind the client to not bend the knee of the affected leg while
seated
3. Encourage the use of an abduction pillow or splint between the
legs
4. Provide a seat riser for the toilet or commode
5. Encourage the client to use the incentive spirometer every 2 hours
Assist the client with a clear liquid diet - >>ANSWER>>1,3,4,5
To prevent postoperative complications and complications related to
immobility, the client should be up in a chair as soon as possible after
surgery. While seated, the client should bend the affected leg at the
knee. The nurse should reinforce teaching of simple leg exercises
while in bed and the use of an abduction pillow or foam wedge to
prevent adduction. To prevent atelectasis and pneumonia the client
should be encouraged to use an incentive spirometer every 2 hours.
Once the client is alert after surgery and not experiencing nausea or
vomiting, they can resume a regular diet.
, A nurse is performing physical assessments on adolescents. What
finding should the nurse anticipate concerning female growth spurts?
Occur about two years earlier than for males
Begin about the same time for males
Start just prior to the onset of puberty
Characterized by an increase in height of 4 inches each year -
>>ANSWER>>Occur about two years earlier than for males
A nurse is caring for a client following a Computed Tomography (CT)
scan of the kidneys with contrast. Which of these findings would
require prompt intervention by the nurse?
Soreness reported at the IV site
Elevated serum creatinine above baseline
The client states that the urethra feels irritated and sore from the
catheter
NCLEX RN (NGN) 2023/2024
VERIFIED 200 QUESTIONS and
Answers with Rationale
A nurse is teaching a mother who will breast-feed for the first time.
Which of these approaches is a priority?
Give the mother privacy for the initial feeding
Assist the mother to position the newborn at the breast
Give the mother several illustrated pamphlets
Show the mother films on the physiology of lactation -
>>ANSWER>>Assist the mother to position the newborn at the breast
All of the approaches should be helpful in teaching. However, the
priority is to place the infant to the breast as soon after birth as
possible to establish contact and allow the newborn to begin to suck.
,The nurse in a long-term care facility is evaluating the plan of care for
an older adult client with advanced dementia. The client has had
several falls out of bed. Which initial intervention should the nurse
implement?
Have the client sleep in a recliner at the nurse's station with a tray
table across their lap
Put the bed in the lowest position with a thick pad or mat on the
floor next to the bed
Correct!
Place the client in a bed with an enclosure mesh tent attached to the
frame
Position all side rails of the bed up and move the bed close to the
door - >>ANSWER>>Falls out of bed are a common occurrence in the
long-term care setting. Although it is nearly impossible to eliminate
all falls, the nurse can implement interventions to reduce the risk for
injury related to a fall. The goal is to start with the least invasive and
restrictive intervention to preserve the client's rights, regardless of
their level of cognitive function. 'Low' beds and 'landing' mats to
soften the fall should the client roll out of bed are commonly used in
long-term care settings and represent an appropriate, initial
intervention to implement for this client. The other interventions are
much more restrictive and should be used only after less restrictive
interventions have been attempted.
,The nurse is developing a plan of care for a client who underwent
total hip arthroplasty 24 hours ago. Which interventions should the
nurse include? Select all that apply.
1. Encourage the client to perform leg exercises while in bed
2. Remind the client to not bend the knee of the affected leg while
seated
3. Encourage the use of an abduction pillow or splint between the
legs
4. Provide a seat riser for the toilet or commode
5. Encourage the client to use the incentive spirometer every 2 hours
Assist the client with a clear liquid diet - >>ANSWER>>1,3,4,5
To prevent postoperative complications and complications related to
immobility, the client should be up in a chair as soon as possible after
surgery. While seated, the client should bend the affected leg at the
knee. The nurse should reinforce teaching of simple leg exercises
while in bed and the use of an abduction pillow or foam wedge to
prevent adduction. To prevent atelectasis and pneumonia the client
should be encouraged to use an incentive spirometer every 2 hours.
Once the client is alert after surgery and not experiencing nausea or
vomiting, they can resume a regular diet.
, A nurse is performing physical assessments on adolescents. What
finding should the nurse anticipate concerning female growth spurts?
Occur about two years earlier than for males
Begin about the same time for males
Start just prior to the onset of puberty
Characterized by an increase in height of 4 inches each year -
>>ANSWER>>Occur about two years earlier than for males
A nurse is caring for a client following a Computed Tomography (CT)
scan of the kidneys with contrast. Which of these findings would
require prompt intervention by the nurse?
Soreness reported at the IV site
Elevated serum creatinine above baseline
The client states that the urethra feels irritated and sore from the
catheter
