NCLEX Live Review Questions
a 2-year-old child is admitted to the hospital for elective surgery. which
information should be the highest priority for the nurse to document on the
nursing plan of care?
a. the child's rituals and routines at home
b. the parent's religious practices and beliefs
c. the child's ability to separate from the parents
d. the parent's understanding of the child's hospitalization - ANS - a. the child's
rituals and routines at home
\a 54-year-old client recently diagnosed with diabetes mellitus asks about diet
and exercise management. the nurse recognizes a need for further education
based on which statement by the client?
a. "I need to carry glucose tablets to the gym"
b. "it is okay to exercise if my blood sugar is less than 240 mg/dL"
c. "I should not eat before running, to prevent complications"
d. "it is important to walk 20 minutes a day to improve my health" - ANS - c. "I
should not eat before running, to prevent complications"
\a charge nurse reviews laboratory results for multiple clients. which conditions
must be reported to public health services? select all that apply.
a. rotavirus
b. pertussis
c. shigellosis
d. gonorrhea
e. lyme disease
f. meningococcal meningitis - ANS - b. pertussis
c. shigellosis
d. gonorrhea
e. lyme disease
f. meningococcal meningitis
\a child who has hemophilia is being discharge home. the nurse should teach the
parents to use which measures if a child sustains an injury? select all that apply.
a. place ice over the injured tissue
b. provide passive range of motion
c. apply pressure directly if bleeding
d. soak the affected area in warm water
e. keep injured extremity above the heart
,f. administer replacement clotting factors - ANS - a. place ice over the injured
tissue
c. apply pressure directly if bleeding
e. keep injured extremity above the heart
f. administer replacement clotting factors
\a client diagnosed with pneumonia received ceftriaxone 1 g IV every 12 hours for
4 days. which of the following statements should be of most concern to the
nurse?
a. "my IV site is a little tender"
b. "I still have a productive cough"
c. "I feel nauseated every time I eat"
d. "I have had runny diarrhea all day" - ANS - d. "I have had runny diarrhea all
day"
\a client had a ventral hernia repair 4 days ago. when performing suture line care,
which action should the nurse take?
a. remove crusty exudate with sterile saline
b. obtain culture and sensitivity of drainage
c. reinforce the dressing with an adhesive bandage
d. maintain aseptic technique during dressing change - ANS - d. maintain aseptic
technique during dressing change
\a client has a patent 20-gauge catheter inserted to the inner arm. which solutions
can be safely administered via the peripheral access? select all that apply.
a. one unit packed RBCs for severe anemia
b. TPN for pancreatitis
c. amiodarone infusion for v-fib
d. dextrose 5% in 0.9% sodium chloride with 40 mEq KCl/L for dehydration
e. intermittent infusion of 40 mg methylprednisolone for status asthmaticus - ANS
- a. one unit packed RBCs for severe anemia
c. amiodarone infusion for v-fib
d. dextrose 5% in 0.9% sodium chloride with 40 mEq KCl/L for dehydration
e. intermittent infusion of 40 mg methylprednisolone for status asthmaticus
\a client has a sealed radiation implant. which actions should the nurse
implement? select all that apply.
a. save linens in client's room
b. assign client to a private room
c. limit each visitor to 30 minutes a day
d. instruct friends to stand 3 feet from the client
e. place a "caution: radioactive material" sign on door - ANS - a. save linens in
client's room
b. assign client to a private room
, c. limit each visitor to 30 minutes a day
e. place a "caution: radioactive material" sign on door
\a client has burns to 25% of the lower extremities. which actions should the
nurse plan to implement when assisting with wound care? select all that apply.
a. fill whirlpool with tepid water
b. wash areas with mild soap and water
c. remove loose, dead tissue with scissors
d. apply topical antibiotics and gauze dressing
e. apply bandage in a distal to proximal direction - ANS - b. wash areas with mild
soap and water
c. remove loose, dead tissue with scissors
d. apply topical antibiotics and gauze dressing
e. apply bandage in a distal to proximal direction
\a client in group therapy has difficulty focusing on one topic and changes the
subject frequently. the nurse responds, "let's return to what we were discussing."
which therapeutic communication technique is being used?
a. focusing
b. exploring
c. reflecting
d. summarizing - ANS - a. focusing
\a client is admitted to the ICU following an open reduction and internal fixation of
the right femur. the client is suddenly agitated and reports chest pain and
shortness of breath. petechiae are present over the chest. which action should
the nurse perform immediately?
a. give methylprednisolone IV
b. obtain pulse oximetry reading
c. administer oxygen via facemask
d. request therapist to provide an albuterol aerosol - ANS - c. administer oxygen
via facemask
\a client is exhibiting signs of severe anxiety related to a previous traumatic
injury. which actions indicate treatment is effective? select all that apply.
a. the client asks for no visitors each day
b. the client asks for assistance to take walks
c. the client consistently discusses flashbacks
d. the client consistently sleeps 7 hours per night
e. the client recognizes symptoms as related to trauma - ANS - b. the client asks
for assistance to take walks
d. the client consistently sleeps 7 hours per night
e. the client recognizes symptoms as related to trauma
a 2-year-old child is admitted to the hospital for elective surgery. which
information should be the highest priority for the nurse to document on the
nursing plan of care?
a. the child's rituals and routines at home
b. the parent's religious practices and beliefs
c. the child's ability to separate from the parents
d. the parent's understanding of the child's hospitalization - ANS - a. the child's
rituals and routines at home
\a 54-year-old client recently diagnosed with diabetes mellitus asks about diet
and exercise management. the nurse recognizes a need for further education
based on which statement by the client?
a. "I need to carry glucose tablets to the gym"
b. "it is okay to exercise if my blood sugar is less than 240 mg/dL"
c. "I should not eat before running, to prevent complications"
d. "it is important to walk 20 minutes a day to improve my health" - ANS - c. "I
should not eat before running, to prevent complications"
\a charge nurse reviews laboratory results for multiple clients. which conditions
must be reported to public health services? select all that apply.
a. rotavirus
b. pertussis
c. shigellosis
d. gonorrhea
e. lyme disease
f. meningococcal meningitis - ANS - b. pertussis
c. shigellosis
d. gonorrhea
e. lyme disease
f. meningococcal meningitis
\a child who has hemophilia is being discharge home. the nurse should teach the
parents to use which measures if a child sustains an injury? select all that apply.
a. place ice over the injured tissue
b. provide passive range of motion
c. apply pressure directly if bleeding
d. soak the affected area in warm water
e. keep injured extremity above the heart
,f. administer replacement clotting factors - ANS - a. place ice over the injured
tissue
c. apply pressure directly if bleeding
e. keep injured extremity above the heart
f. administer replacement clotting factors
\a client diagnosed with pneumonia received ceftriaxone 1 g IV every 12 hours for
4 days. which of the following statements should be of most concern to the
nurse?
a. "my IV site is a little tender"
b. "I still have a productive cough"
c. "I feel nauseated every time I eat"
d. "I have had runny diarrhea all day" - ANS - d. "I have had runny diarrhea all
day"
\a client had a ventral hernia repair 4 days ago. when performing suture line care,
which action should the nurse take?
a. remove crusty exudate with sterile saline
b. obtain culture and sensitivity of drainage
c. reinforce the dressing with an adhesive bandage
d. maintain aseptic technique during dressing change - ANS - d. maintain aseptic
technique during dressing change
\a client has a patent 20-gauge catheter inserted to the inner arm. which solutions
can be safely administered via the peripheral access? select all that apply.
a. one unit packed RBCs for severe anemia
b. TPN for pancreatitis
c. amiodarone infusion for v-fib
d. dextrose 5% in 0.9% sodium chloride with 40 mEq KCl/L for dehydration
e. intermittent infusion of 40 mg methylprednisolone for status asthmaticus - ANS
- a. one unit packed RBCs for severe anemia
c. amiodarone infusion for v-fib
d. dextrose 5% in 0.9% sodium chloride with 40 mEq KCl/L for dehydration
e. intermittent infusion of 40 mg methylprednisolone for status asthmaticus
\a client has a sealed radiation implant. which actions should the nurse
implement? select all that apply.
a. save linens in client's room
b. assign client to a private room
c. limit each visitor to 30 minutes a day
d. instruct friends to stand 3 feet from the client
e. place a "caution: radioactive material" sign on door - ANS - a. save linens in
client's room
b. assign client to a private room
, c. limit each visitor to 30 minutes a day
e. place a "caution: radioactive material" sign on door
\a client has burns to 25% of the lower extremities. which actions should the
nurse plan to implement when assisting with wound care? select all that apply.
a. fill whirlpool with tepid water
b. wash areas with mild soap and water
c. remove loose, dead tissue with scissors
d. apply topical antibiotics and gauze dressing
e. apply bandage in a distal to proximal direction - ANS - b. wash areas with mild
soap and water
c. remove loose, dead tissue with scissors
d. apply topical antibiotics and gauze dressing
e. apply bandage in a distal to proximal direction
\a client in group therapy has difficulty focusing on one topic and changes the
subject frequently. the nurse responds, "let's return to what we were discussing."
which therapeutic communication technique is being used?
a. focusing
b. exploring
c. reflecting
d. summarizing - ANS - a. focusing
\a client is admitted to the ICU following an open reduction and internal fixation of
the right femur. the client is suddenly agitated and reports chest pain and
shortness of breath. petechiae are present over the chest. which action should
the nurse perform immediately?
a. give methylprednisolone IV
b. obtain pulse oximetry reading
c. administer oxygen via facemask
d. request therapist to provide an albuterol aerosol - ANS - c. administer oxygen
via facemask
\a client is exhibiting signs of severe anxiety related to a previous traumatic
injury. which actions indicate treatment is effective? select all that apply.
a. the client asks for no visitors each day
b. the client asks for assistance to take walks
c. the client consistently discusses flashbacks
d. the client consistently sleeps 7 hours per night
e. the client recognizes symptoms as related to trauma - ANS - b. the client asks
for assistance to take walks
d. the client consistently sleeps 7 hours per night
e. the client recognizes symptoms as related to trauma
