NCLEX Practice Questions
A 34-year-old woman who developed Stevens-Johnson syndrome while
undergoing treatment with carbamazepine (Tegretol) is being transferred in stable
condition from the intensive care unit to the medical unit. There are 4 beds
available. The nurse knows the best choice of roommates for this client is which
of the following?
(a) A 40-year-old man with methicillin-resistant Staphylococcus aureus (MRSA).
(b) A 28-year-old woman diagnosed with diarrhea.
(c) A 72-year-old man with fever of unknown origin.
(d) A 68-year-old woman with atrial fibrillation . - ANS - Correct answer: (d) A
68-year-old woman with atrial fibrillation.
Rationale: A client with Stevens-Johnson syndrome is likely to have severe skin
integrity issues, including blistering and skin shedding, which can place the
client at high risk for infection. Atrial fibrillation is not an infectious process. All
other patients may be an infection risk for an individual with altered skin integrity.
\A 72-year-old man who had a stroke is being transferred from a medical unit to a
rehabilitation centre. The nurse case manager is assisting in the process. The
nurse knows that the goals of case management include which of the following?
Select all that apply.
(a) Improving the coordination of care
(b) Increasing referrals to local organizations
(c) Reducing the fragmentation of care
(d) Discharging clients quickly - ANS - Correct answer: (a) Improving the
coordination of care; and (c) Reducing the fragmentation of care
Rationale: Some of the primary goals of case management are to improve the
coordination of care and to reduce fragmentation of care. The other options are
not goals of case management.
\A nursing team consists of an RN, an LPN/ LVN, and a nursing assistant. The
nurse should assign which of the following patients to the LPN/LVN?
(a) A 72-year-old patient with diabetes who requires a dressing change for a
stasis ulcer.
(b) A 42-year-old patient with cancer of the bone complaining of pain.
, (c) A 55-year-old patient with terminal cancer being transferred to hospice home
care.
(d) A 23-year-old patient with a fracture of the right leg who asks to use the urinal.
- ANS - Correct answer: (a) A 72-year-old patient with diabetes who requires a
dressing change for a stasis ulcer.
Rationale: LPN/LVNs assist with implementation of care; performs procedures;
differentiates normal from abnormal; cares for stable patients with predictable
conditions; has knowledge of asepsis and dressing changes; administers
medications. Patient (a) is stable with an expected outcome. Patients (b) and (c)
require assessment and nursing judgement; and Patient (d) involves a standard
unchanging procedure that can be assigned to the nursing assistant.
\A pregnant woman at 15 weeks' gestation is scheduled for an amniocentesis. As
the client is being prepped for the procedure, it becomes clear to the nurse that
the client doesn't fully understand the risks and benefits associated with the
procedure. Which of the following describe the nurse's role in obtaining informed
consent? Select all that apply.
(a) Explain the risks and benefits associated with the procedure.
(b) Describe alternatives to the procedure.
(c) Witness the client's signature on the consent form.
(d) Advocate for the client by ensuring she is making an informed decision. - ANS
- Correct answer: (c) Witness the client's signature on the consent form; and
(d) Advocate for the client by ensuring she is making an informed decision.
Rationale: Some of the nurse's roles in the informed consent process are to
witness the signature on the consent form, and to advocate for the client by
ensuring she has been provided the necessary information to make an informed
decision. It is the physician's duty to provide information to the client-related
risks and benefits, and to provide alternatives.
\A registered nurse is planning the client assignments for the day. Which of the
following is the most appropriate assignment for the nursing assistant?
(a) A client requiring colostomy irrigation
(b) A client receiving continuous tube feedings
(c) A client who requires stool specimen collections
(d) A client who has difficulty swallowing food and fluids - ANS - Correct answer:
(c) A client who requires stool specimen collections
A 34-year-old woman who developed Stevens-Johnson syndrome while
undergoing treatment with carbamazepine (Tegretol) is being transferred in stable
condition from the intensive care unit to the medical unit. There are 4 beds
available. The nurse knows the best choice of roommates for this client is which
of the following?
(a) A 40-year-old man with methicillin-resistant Staphylococcus aureus (MRSA).
(b) A 28-year-old woman diagnosed with diarrhea.
(c) A 72-year-old man with fever of unknown origin.
(d) A 68-year-old woman with atrial fibrillation . - ANS - Correct answer: (d) A
68-year-old woman with atrial fibrillation.
Rationale: A client with Stevens-Johnson syndrome is likely to have severe skin
integrity issues, including blistering and skin shedding, which can place the
client at high risk for infection. Atrial fibrillation is not an infectious process. All
other patients may be an infection risk for an individual with altered skin integrity.
\A 72-year-old man who had a stroke is being transferred from a medical unit to a
rehabilitation centre. The nurse case manager is assisting in the process. The
nurse knows that the goals of case management include which of the following?
Select all that apply.
(a) Improving the coordination of care
(b) Increasing referrals to local organizations
(c) Reducing the fragmentation of care
(d) Discharging clients quickly - ANS - Correct answer: (a) Improving the
coordination of care; and (c) Reducing the fragmentation of care
Rationale: Some of the primary goals of case management are to improve the
coordination of care and to reduce fragmentation of care. The other options are
not goals of case management.
\A nursing team consists of an RN, an LPN/ LVN, and a nursing assistant. The
nurse should assign which of the following patients to the LPN/LVN?
(a) A 72-year-old patient with diabetes who requires a dressing change for a
stasis ulcer.
(b) A 42-year-old patient with cancer of the bone complaining of pain.
, (c) A 55-year-old patient with terminal cancer being transferred to hospice home
care.
(d) A 23-year-old patient with a fracture of the right leg who asks to use the urinal.
- ANS - Correct answer: (a) A 72-year-old patient with diabetes who requires a
dressing change for a stasis ulcer.
Rationale: LPN/LVNs assist with implementation of care; performs procedures;
differentiates normal from abnormal; cares for stable patients with predictable
conditions; has knowledge of asepsis and dressing changes; administers
medications. Patient (a) is stable with an expected outcome. Patients (b) and (c)
require assessment and nursing judgement; and Patient (d) involves a standard
unchanging procedure that can be assigned to the nursing assistant.
\A pregnant woman at 15 weeks' gestation is scheduled for an amniocentesis. As
the client is being prepped for the procedure, it becomes clear to the nurse that
the client doesn't fully understand the risks and benefits associated with the
procedure. Which of the following describe the nurse's role in obtaining informed
consent? Select all that apply.
(a) Explain the risks and benefits associated with the procedure.
(b) Describe alternatives to the procedure.
(c) Witness the client's signature on the consent form.
(d) Advocate for the client by ensuring she is making an informed decision. - ANS
- Correct answer: (c) Witness the client's signature on the consent form; and
(d) Advocate for the client by ensuring she is making an informed decision.
Rationale: Some of the nurse's roles in the informed consent process are to
witness the signature on the consent form, and to advocate for the client by
ensuring she has been provided the necessary information to make an informed
decision. It is the physician's duty to provide information to the client-related
risks and benefits, and to provide alternatives.
\A registered nurse is planning the client assignments for the day. Which of the
following is the most appropriate assignment for the nursing assistant?
(a) A client requiring colostomy irrigation
(b) A client receiving continuous tube feedings
(c) A client who requires stool specimen collections
(d) A client who has difficulty swallowing food and fluids - ANS - Correct answer:
(c) A client who requires stool specimen collections
