6/23/26, 9:59 PM NCLEX EXAM PREVIEW Flashcards | Quizlet
Nightingale College BSN 366
NCLEX EXAM PREVIEW
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Terms in this set (110)
The charge nurse has received a change-of-shift report 2. first stage of labor whose contractions are occurring every 30
seconds on the following clients in labor. The charge nurse Contractions should be no longer than 90 secs and no closer than
2 mins (120 should ask a staff member to first see the client in the secs)
1. first stage of labor who has an oral temperature of 90 secs is the duration, 2 mins is the frequency.
99.7° F (37.6° C)
2. first stage of labor whose contractions are occurring Rationale:
every 30 seconds 1. Elevated temp is normal during labor
3. second stage of labor who has respirations of 26 3. Increased resps are normal during labor "pant-pant-blow" "hee-hee-
hoo" 4. second stage of labor whose contractions are lasting
breathing pattern for 60 seconds 4. Contractions shouldn't be longer than 90 secs, 60 secs is okay and normal Second stage:
2-3 mins apart, 60-90 secs long, 10 cm dilated, strong pain
The nurse is observing a staff member caring for a 2. placing a box of disposable face shields outside the client's room
client who has chickenpox. disposable face masks are not suitable for airborne precautions
Which of the following actions by the staff member
would require the nurse to intervene? Rationale:
1. placing the client in a private room with monitored
Varicella (chickenpox) is airborne precaution. Private, negative pressure room, negative air pressure universal precautions
(hand sanitizer in room) and placing surgical mask on 2. placing a box of disposable face shields outside the client during
transport are all correct interventions for Varicilla.
client's room
3. placing an alcohol-based hand rub in the
client's
room for hand hygiene
4. placing a surgical mask on the client during
transport
out of the client's room
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,6/23/26, 9:59 PM NCLEX EXAM PREVIEW Flashcards | Quizlet
The nurse is planning care for a client with moderate 1. Encourage the client to reminisce about happy memories.
Alzheimer's disease (AD). Its possible for AD patients to retain long-term memories
Which of the following interventions should the nurse
include in the client's plan of care? Rationale:
1. Encourage the client to reminisce about happy 2. Acknowledge feelings --> Redirect is protocol for Dementia. Don't
confront; memories.
they can't learn 2. Confront the client when inappropriate or agitated 3. AD is irreversible
behaviors occur. 4. In moderate AD, dementia has already progressed to where pt needs help 3. Administer to the client the
cholinesterase inhibitor to with ADLs and planning daily activities. Asking them to plan can frustrate them reverse the course
of AD. and cause distress.
4. Provide the client with information about activity STRUCTURED pleasant activities that consider the persons likes and
interests choices in the morning so the client can make plans for are the best.
the day.
The nurse is teaching a client how to ambulate using 1. "Use your hands and arms to support your body weight."
crutches. Which of the following information should the True! But watch out if it isn't 2-3 finger-widths, crutch paralysis
can occur. s/s: nurse include? paresis and paresthesias in wrists and hands
1. "Use your hands and arms to support your body
weight."
Rationales: 2. "Wear slippers when ambulating with the crutches in 2. Fall risk!
your home." 3. Should be 6 in. in front and 6 in. lateral 3. "Maintain the crutches 12 in (30
cm) in front of your 4. Elbows should be bent at 30 degree angle feet while standing."
4. "Adjust the hand grips of the crutches so that your
elbows are fully extended."
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, 6/23/26, 9:59 PM NCLEX EXAM PREVIEW Flashcards | Quizlet
The nurse has taught a client with multiple sclerosis 4. "I should expect the blurred vision to resolve after I have
received (MS). medications for several weeks."
Which of the following statements by the client would MS causes nerve damage and can result in optic neuritis (vision loss,
burry indicate a correct understanding of the teaching? vision). In most cases it resolves itself in 4-12 weeks, but
medication (steroids) 1. "I will complete all of my household chores in the can speed up the process and resolve it quicker
morning when I am well rested."
2. "I have learned how to massage my bladder to help Rationale:
empty my bladder completely." 1. MS patients should not exert themselves too much at one time. Space out 3. "I will take a
hot bath in the evening to help me relax activities and allow time for rest.
if I have had a stressful day at work." 2. Urinary retention is primarily treated by medication (bethanochol), and 4. "I
should expect the blurred vision to resolve after I exercises can aid with it but are not the primary treatment
have received medications for several weeks." 3. Hot temperatures are bad for MS and can worsen symptoms. Your nerves are
already fcked up and extra heat can stress your body into overdrive
The nurse has attended a staff education program 2. "Clients may develop stress ulcers and gastrointestinal bleeding." about
caring for clients who are receiving positive Rationale: Postive Pressure Ventilation may cause stress ulcers and GI bleeding
pressure mechanical ventilation. Which of the following because
statements by the nurse would indicate a correct
understanding of the teaching?
1. "Clients should avoid range-of-motion
(ROM)
exercises until weaned from ventilation."
2. "Clients may develop stress ulcers and
gastrointestinal bleeding."
3. "Clients will be chemically paralyzed to
improve
oxygenation."
4.
The"Clients will experience
charge nurse diuresis
must transfer andclient from the 3. 56 years old, has hepatitis C (HCV) and has been afebrile for
a female
polyuria."
24 hours medical-surgical unit to the maternity unit to make a
bed available. It would be most appropriate for the
nurse to transfer the client who is
1. 28 years old, had a right mastectomy and has a
closed-wound drainage system
2. 49 years old, has diabetes mellitus (type 2) and has
begun receiving insulin
3. 56 years old, has hepatitis C (HCV) and has been
afebrile for 24 hours
4. 70 years old, has a fractured left tibia and had an
external fixation device applied 48 hours ago
The nurse has been made aware of the following client 1. heart failure who has a productive cough and is anxious
situations. The nurse should first assess the client with: Productive cough (pink frothy sputum) indicates pulmonary edema,
anxiety 1. heart failure who has a productive cough and is might be caused by decreased perfusion
anxious
2. regional enteritis (Crohn's disease) who is reporting
cramping abdominal pain and diarrhea
3. idiopathic thrombocytopenic purpura (ITP) who has
petechiae on the trunk and is reporting heavy menses
4. chronic obstructive pulmonary disease (COPD) who
has dyspnea with exertion and is using accessory
muscles to breathe
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Nightingale College BSN 366
NCLEX EXAM PREVIEW
16 studying now 3.7 (424 reviews)
Save
Students also studied
Flashcard sets Study guides
NCLEX-RN Exam Preview 75 Free NCLEX Questions - c/o NCLEX-RN Practice Questions For 2... PE
Brilli...
113 terms 75 terms Teacher 34 terms 199
lalaitsdestinee Preview carey47 Preview TutorDk Preview
Terms in this set (110)
The charge nurse has received a change-of-shift report 2. first stage of labor whose contractions are occurring every 30
seconds on the following clients in labor. The charge nurse Contractions should be no longer than 90 secs and no closer than
2 mins (120 should ask a staff member to first see the client in the secs)
1. first stage of labor who has an oral temperature of 90 secs is the duration, 2 mins is the frequency.
99.7° F (37.6° C)
2. first stage of labor whose contractions are occurring Rationale:
every 30 seconds 1. Elevated temp is normal during labor
3. second stage of labor who has respirations of 26 3. Increased resps are normal during labor "pant-pant-blow" "hee-hee-
hoo" 4. second stage of labor whose contractions are lasting
breathing pattern for 60 seconds 4. Contractions shouldn't be longer than 90 secs, 60 secs is okay and normal Second stage:
2-3 mins apart, 60-90 secs long, 10 cm dilated, strong pain
The nurse is observing a staff member caring for a 2. placing a box of disposable face shields outside the client's room
client who has chickenpox. disposable face masks are not suitable for airborne precautions
Which of the following actions by the staff member
would require the nurse to intervene? Rationale:
1. placing the client in a private room with monitored
Varicella (chickenpox) is airborne precaution. Private, negative pressure room, negative air pressure universal precautions
(hand sanitizer in room) and placing surgical mask on 2. placing a box of disposable face shields outside the client during
transport are all correct interventions for Varicilla.
client's room
3. placing an alcohol-based hand rub in the
client's
room for hand hygiene
4. placing a surgical mask on the client during
transport
out of the client's room
https://quizlet.com/817663965/nclex-exam-preview-flash-cards/?funnelUUID=c80ac221-8508-445b-9800-74603125f1de 1/24
,6/23/26, 9:59 PM NCLEX EXAM PREVIEW Flashcards | Quizlet
The nurse is planning care for a client with moderate 1. Encourage the client to reminisce about happy memories.
Alzheimer's disease (AD). Its possible for AD patients to retain long-term memories
Which of the following interventions should the nurse
include in the client's plan of care? Rationale:
1. Encourage the client to reminisce about happy 2. Acknowledge feelings --> Redirect is protocol for Dementia. Don't
confront; memories.
they can't learn 2. Confront the client when inappropriate or agitated 3. AD is irreversible
behaviors occur. 4. In moderate AD, dementia has already progressed to where pt needs help 3. Administer to the client the
cholinesterase inhibitor to with ADLs and planning daily activities. Asking them to plan can frustrate them reverse the course
of AD. and cause distress.
4. Provide the client with information about activity STRUCTURED pleasant activities that consider the persons likes and
interests choices in the morning so the client can make plans for are the best.
the day.
The nurse is teaching a client how to ambulate using 1. "Use your hands and arms to support your body weight."
crutches. Which of the following information should the True! But watch out if it isn't 2-3 finger-widths, crutch paralysis
can occur. s/s: nurse include? paresis and paresthesias in wrists and hands
1. "Use your hands and arms to support your body
weight."
Rationales: 2. "Wear slippers when ambulating with the crutches in 2. Fall risk!
your home." 3. Should be 6 in. in front and 6 in. lateral 3. "Maintain the crutches 12 in (30
cm) in front of your 4. Elbows should be bent at 30 degree angle feet while standing."
4. "Adjust the hand grips of the crutches so that your
elbows are fully extended."
https://quizlet.com/817663965/nclex-exam-preview-flash-cards/?funnelUUID=c80ac221-8508-445b-9800-74603125f1de 2/24
, 6/23/26, 9:59 PM NCLEX EXAM PREVIEW Flashcards | Quizlet
The nurse has taught a client with multiple sclerosis 4. "I should expect the blurred vision to resolve after I have
received (MS). medications for several weeks."
Which of the following statements by the client would MS causes nerve damage and can result in optic neuritis (vision loss,
burry indicate a correct understanding of the teaching? vision). In most cases it resolves itself in 4-12 weeks, but
medication (steroids) 1. "I will complete all of my household chores in the can speed up the process and resolve it quicker
morning when I am well rested."
2. "I have learned how to massage my bladder to help Rationale:
empty my bladder completely." 1. MS patients should not exert themselves too much at one time. Space out 3. "I will take a
hot bath in the evening to help me relax activities and allow time for rest.
if I have had a stressful day at work." 2. Urinary retention is primarily treated by medication (bethanochol), and 4. "I
should expect the blurred vision to resolve after I exercises can aid with it but are not the primary treatment
have received medications for several weeks." 3. Hot temperatures are bad for MS and can worsen symptoms. Your nerves are
already fcked up and extra heat can stress your body into overdrive
The nurse has attended a staff education program 2. "Clients may develop stress ulcers and gastrointestinal bleeding." about
caring for clients who are receiving positive Rationale: Postive Pressure Ventilation may cause stress ulcers and GI bleeding
pressure mechanical ventilation. Which of the following because
statements by the nurse would indicate a correct
understanding of the teaching?
1. "Clients should avoid range-of-motion
(ROM)
exercises until weaned from ventilation."
2. "Clients may develop stress ulcers and
gastrointestinal bleeding."
3. "Clients will be chemically paralyzed to
improve
oxygenation."
4.
The"Clients will experience
charge nurse diuresis
must transfer andclient from the 3. 56 years old, has hepatitis C (HCV) and has been afebrile for
a female
polyuria."
24 hours medical-surgical unit to the maternity unit to make a
bed available. It would be most appropriate for the
nurse to transfer the client who is
1. 28 years old, had a right mastectomy and has a
closed-wound drainage system
2. 49 years old, has diabetes mellitus (type 2) and has
begun receiving insulin
3. 56 years old, has hepatitis C (HCV) and has been
afebrile for 24 hours
4. 70 years old, has a fractured left tibia and had an
external fixation device applied 48 hours ago
The nurse has been made aware of the following client 1. heart failure who has a productive cough and is anxious
situations. The nurse should first assess the client with: Productive cough (pink frothy sputum) indicates pulmonary edema,
anxiety 1. heart failure who has a productive cough and is might be caused by decreased perfusion
anxious
2. regional enteritis (Crohn's disease) who is reporting
cramping abdominal pain and diarrhea
3. idiopathic thrombocytopenic purpura (ITP) who has
petechiae on the trunk and is reporting heavy menses
4. chronic obstructive pulmonary disease (COPD) who
has dyspnea with exertion and is using accessory
muscles to breathe
https://quizlet.com/817663965/nclex-exam-preview-flash-cards/?funnelUUID=c80ac221-8508-445b-9800-74603125f1de 3/24
