NCSBN TEST-BANK - FOR THE NCLEX-RN & NCLEX- PN, UPDATED 2023, ALL QUESTIONS & ANSWERS WITH RATIONALE

NCSBN TEST-BANK - FOR THE NCLEX-RN & NCLEX-
PN, UPDATED 2023, ALL QUESTIONS & ANSWERS
WITH RATIONALE




Multiple Questions with Answers
Question 1


A c. What document should be in guiding the care of this client?


A) Client Self Determination Act


B) Physician's treatment orders


C) Advance Directives.


D) Clinical Pathway protocols


Review Information: CORRECT ANS >> is: C) Advance Directives. This document speci$es the
client's wishes




Question 2


You are the of a health care team that consists of one licensed practical/vocational nurse, one nursing
assistant , a nursing student and yourself. To whom is it appropriate to assign complete care for


A) Yourself


B) The nursing student


C) The licensed vocational nurse


D) The nursing assistant


Review Information: CORRECT ANS >> is:A) Yourself.

,While the nurse may delegate a bed bath for a stable client, this care should be performed by an RN for a
new admission. Only tasks that do not require independent judgment should be delegated.




3Question 3


A mother brings her the clinic, complaining that the child seems to be The nurse expects to $nd which of
the following on the initial history and physical assessment?


A) Increased temperature and lethargy


B) Rash and restlessness


C) Increased sleeping and listlessness


D) Diarrhea and poor skin turgor


Review Information: CORRECT ANS >> is:B) Rash and restlessness.

,Question m4


As mthe mnurse mtakes ma mhistory mof ma m3 myear-old mwith mneuroblastoma, mwhat mcomments mby mthe mparents
mrequire mfollow-up mand mare mconsistent mwith mthe mdiagnosis?



A) "The mchild mhas mbeen mlistless mand mhas mlost mweight."


B) "Her murine mis mdark myellow mand msmall min mamounts."


C) "Clothes mare mbecoming mtighter macross mher mabdomen."


mD+) m"We mnotice mmuscle mweakness mand msome



munsteadiness."




Review m Information: m m CORRECT mANS m>> m is:C) m "Clothes mare m becoming m tighter m across m her m abdomen.".



One mof mthe mmost mcommon msigns mof mneuroblastoma mis mincreasing mabdominal mgirth. mThe mparents'' mreport
mthat mclothing mis mtight mis msigni$cant, mand mshould mbe mfollowed mby madditional massessments.




Question m5


A m16 myear-old mpresents mto mthe memergency mdepartment. mThe mtriage mnurse m$nds mthat mthis mteenager mis
mlegally mmarried mand msigned mthe mconsent mform mfor mtreatment. mWhat mwould mbe mthe mappropriate mINITIAL
maction mby mthe mnurse?



A) Refuse mto msee mthe mclient muntil ma mparent mor mlegal mguardian mcan mbe mcontacted


B) Withhold mtreatment muntil mtelephone mconsent mcan m be mobtained mfrom mthe mspouse


C) Refer mthe mclient mto ma mcommunity mpediatric mhospital memergency mroom


D) Assess mand m treat m in mthe m same mmanner m as many madult mclient


Review m Information: CORRECT mANS m>> m is:D) mAssess mand mtreat min mthe msame mmanner mas many madult
mclient.



Minors mmay m become m known m as man m "emancipated mminor" mthrough mmarriage, mpregnancy, mhigh m school
mgraduation, mindependent mliving mor mservice min mthe mmilitary. mTherefore, mthis mclient, mwho mis mmarried, mhas mthe mlegal
mcapacity mof man m adult.




Question m6


A mnewly madmitted melderly mclient mis mseverely mdehydrated. mWhen mplanning mcare mfor mthis mclient, mwhich mone mof mthe
mfollowing mis man mappropriate mtask mfor man mUnlicensed mAssistive mPersonnel m(UAP)?

, A) Obtain ma mhistory mof m;uid mloss


B) Report moutput mof mless mthan m30 mml/hr


C) Monitor mresponse mto mIV m;uids


D) Check mskin mturgor mevery mfour mhours


Review m Information: CORRECT mANS m>> m is:B) m Report moutput m of m less mthan m30 m ml/hr.



When mdirecting ma mUAP, m the mnurse mmust mcommunicate mclearly mabout meach mdelegated mtask mwith mspeci$c
minstructions mon mwhat mmust mbe mreported. mBecause mthe mRN mis mresponsible mfor mall mcare-related mdecisions,only
mimplementation mtasks mshould mbe massigned mbecause mthey mdo m not m require m independent mjudgment.




Question m7


The mnurse mis massessing ma m4 myear-old mfor mpossible mrheumatic mfever. mWhich mof mthe mfollowing mwould mthe mnurse
msuspect mis mrelated mto mthis mdiagnosis?



A) Diagnosis m of m chickenpox m six mmonths mago


B) Exposure mto mstrep mthroat min mdaycare mlast mmonth


C) Treatment mfor mear minfection mtwo mmonths mago


D) Episode mof mfungal mskin minfection mlast mweek


Review mInformation: m CORRECT mANS m>> m is:B) mExposure mto mstrep mthroat min mdaycare mlast mmonth.


Evidence msupports ma mstrong mrelationship mbetween minfection mwith mGroup mA mstreptococci mand msubsequent
mrheumatic mfever m(usually mwithin m2-6 mweeks). mTherefore, mthe mhistory mof mplaymates mrecovering mfrom
mstrep mthroat mwould mindicate mthat mthe mchild mdiagnosed mwith mrheumatic mfever mmost mlikely malso mhad
mstrep mthroat. mSometimes, msuch man minfection mhas mno mclinical msymptoms.




Question m8


When mthe mnurse mbecomes maware mof mfeeling mreluctant mto minteract mwith ma mmanipulative mclient, mthe mBEST
maction mby mthe mnurse mis mto



A) Discuss mthe mfeeling mof mreluctance mwith man mobjective mpeer mor msupervisor


B) Limit mcontacts mwith mthe mclient mto mavoid mreinforcing mthe mmanipulative mbehavior


C) Confront mthe mclient mregarding mthe mnegative meffects mof mhis/her mbehavior mon mothers


D) Develop ma mbehavior mmodi$cation mplan mthat mwill m promote mmore mfunctional mbehavior


Review mInformation: m CORRECT mANS m>> m is:A) mDiscuss mthe mfeeling mof mreluctance mwith man mobjective
mpeer mor m supervisor.



The mnurse mwho mis mexperiencing mstress min mthe mtherapeutic mrelationship mcan mgain mobjectivity mthrough
msupervision. mThe mnurse mmust mattempt mto mdiscover mattitudes mand mfeelings min mthe mself mthat min;uence mthe
mnurse- mclient mrelationship.