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NCLEX EXAM PREVIEW | CERTIFIED
EXAM QUESTIONS WITH DETAILED
SOLUTIONS
The nurse is planning a staff education program about caring for clients with
restraints. Which of the following information should the nurse include?
1. "Restraints should be removed once during a shift to perform passive range-of-
motion (ROM) exercises for the client."
2. "Restraints should be secured to the side rails of the client's bed for quick
release."
3. "Restraints require an order from the primary health care provider."
4. "Restraints may be used p.r.n. for clients who are confused." - correct-answer -
3. "Restraints require an order from the primary health care provider."
Rationale:
1. Restraints are removed every 2 HOURS for ROM exercises, toileting, and fluids.
Assess every 15 mins for the first hour and then every 30 minutes
2. Restraints should be secured to the bed, not side rails
4. Restraints are never PRN
The nurse is caring for a client with active pulmonary tuberculosis (TB). Which of
the following should the nurse include in the client's plan of care?
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1. placing the client in a private room with the door open
2. putting a surgical mask on the client during transport to the radiology
department
3. instructing the primary caregivers to wear surgical masks when caring for the
client
4. instituting the standards for droplet precautions while caring for the client -
correct-answer -2. putting a surgical mask on the client during transport to the
radiology department
X-Ray to confirm active TB d(x)
Rationale:
1. Door should be closed
3.
4. Airborne precautions
The home-health nurse is teaching the parents of a 4-year-old client with
impetigo. Which of the following information should the nurse include?
1. "Put a surgical mask on your child when around siblings."
2. "Cleanse the lesions with a povidone-iodine solution daily."
3. "Apply petroleum jelly to the lesions daily."
4. "Instruct your child not to use the same towels as siblings." - correct-answer -4.
"Instruct your child not to use the same towels as siblings."
Impetigo is highly contagious through contact. Towels can easily spread the
infection
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Rationale:
1. It is contact precautions; surgical mask would be for airborne
The nurse has attended a staff education program about bioterrorism. Which of
the following statements by the nurse would require follow-up?
1. "Botulism is transmitted by ingestion of contaminated canned foods."
2. "Hemorrhagic fever is spread by direct contact with blood or body fluids."
3. "Anthrax is spread through direct contact with the bacteria and its spores."
4. "Bubonic plague is transmitted from person to person via airborne droplets." -
correct-answer -4. "Bubonic plague is transmitted from person to person via
airborne droplets."
It is spread through flea bites and contact with infected skin
Rationale:
1. Botulism is transmitted by foods. ex: babies getting Botulism from honey
2. Infectious diseases that affect clotting and is spread by blood or body fluids
3. Anthrax: Contact
The nurse observes a coworker who is assessing a client's thoracic expansion.
Which of the following would indicate that the coworker is using the correct
assessment technique?
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1. percussion from the apex of the scapula downward on each side
2. placement of the hands flat on the back with the thumbs at the level of the
tenth ribs pointing to the spine, then asking the client to inhale
3. measurement of the anteroposterior diameter of the chest
4. placement of the palms at the level of the tenth ribs with thumbs pointing to
the xiphoid process, then asking the client to inhale - correct-answer -4.
placement of the palms at the level of the tenth ribs with thumbs pointing to the
xiphoid process, then asking the client to inhale
This is how to measure anterior thoracic expansion.
2. Posterior thoracic expansion
The nurse at a health fair is talking with a client who is in perimenopause and is
experiencing hot flashes. Which of the following lifestyle modifications would be
appropriate for the nurse to recommend?
1. increasing fluid intake
2. exercising daily
3. decreasing sodium intake
4. wearing clothing in layers - correct-answer -4. wearing clothing in layers
Wear light layers so you can remove layers when you get a hot flash
The nurse in a community-based setting is teaching clients over 65 years of age
about health promotion activities. Which of the following information should the
nurse include?
NCLEX EXAM PREVIEW | CERTIFIED
EXAM QUESTIONS WITH DETAILED
SOLUTIONS
The nurse is planning a staff education program about caring for clients with
restraints. Which of the following information should the nurse include?
1. "Restraints should be removed once during a shift to perform passive range-of-
motion (ROM) exercises for the client."
2. "Restraints should be secured to the side rails of the client's bed for quick
release."
3. "Restraints require an order from the primary health care provider."
4. "Restraints may be used p.r.n. for clients who are confused." - correct-answer -
3. "Restraints require an order from the primary health care provider."
Rationale:
1. Restraints are removed every 2 HOURS for ROM exercises, toileting, and fluids.
Assess every 15 mins for the first hour and then every 30 minutes
2. Restraints should be secured to the bed, not side rails
4. Restraints are never PRN
The nurse is caring for a client with active pulmonary tuberculosis (TB). Which of
the following should the nurse include in the client's plan of care?
,2|Page
1. placing the client in a private room with the door open
2. putting a surgical mask on the client during transport to the radiology
department
3. instructing the primary caregivers to wear surgical masks when caring for the
client
4. instituting the standards for droplet precautions while caring for the client -
correct-answer -2. putting a surgical mask on the client during transport to the
radiology department
X-Ray to confirm active TB d(x)
Rationale:
1. Door should be closed
3.
4. Airborne precautions
The home-health nurse is teaching the parents of a 4-year-old client with
impetigo. Which of the following information should the nurse include?
1. "Put a surgical mask on your child when around siblings."
2. "Cleanse the lesions with a povidone-iodine solution daily."
3. "Apply petroleum jelly to the lesions daily."
4. "Instruct your child not to use the same towels as siblings." - correct-answer -4.
"Instruct your child not to use the same towels as siblings."
Impetigo is highly contagious through contact. Towels can easily spread the
infection
,3|Page
Rationale:
1. It is contact precautions; surgical mask would be for airborne
The nurse has attended a staff education program about bioterrorism. Which of
the following statements by the nurse would require follow-up?
1. "Botulism is transmitted by ingestion of contaminated canned foods."
2. "Hemorrhagic fever is spread by direct contact with blood or body fluids."
3. "Anthrax is spread through direct contact with the bacteria and its spores."
4. "Bubonic plague is transmitted from person to person via airborne droplets." -
correct-answer -4. "Bubonic plague is transmitted from person to person via
airborne droplets."
It is spread through flea bites and contact with infected skin
Rationale:
1. Botulism is transmitted by foods. ex: babies getting Botulism from honey
2. Infectious diseases that affect clotting and is spread by blood or body fluids
3. Anthrax: Contact
The nurse observes a coworker who is assessing a client's thoracic expansion.
Which of the following would indicate that the coworker is using the correct
assessment technique?
, 4|Page
1. percussion from the apex of the scapula downward on each side
2. placement of the hands flat on the back with the thumbs at the level of the
tenth ribs pointing to the spine, then asking the client to inhale
3. measurement of the anteroposterior diameter of the chest
4. placement of the palms at the level of the tenth ribs with thumbs pointing to
the xiphoid process, then asking the client to inhale - correct-answer -4.
placement of the palms at the level of the tenth ribs with thumbs pointing to the
xiphoid process, then asking the client to inhale
This is how to measure anterior thoracic expansion.
2. Posterior thoracic expansion
The nurse at a health fair is talking with a client who is in perimenopause and is
experiencing hot flashes. Which of the following lifestyle modifications would be
appropriate for the nurse to recommend?
1. increasing fluid intake
2. exercising daily
3. decreasing sodium intake
4. wearing clothing in layers - correct-answer -4. wearing clothing in layers
Wear light layers so you can remove layers when you get a hot flash
The nurse in a community-based setting is teaching clients over 65 years of age
about health promotion activities. Which of the following information should the
nurse include?
