NCSBN TEST BANK - for the NCLEX-
RN & NCLEX-PN, UPDATED EDITION,
Complete Questions & Answers with
rationale
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: The correct answer is: C) Advance Directives. This document specifies 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: The correct answer 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 find 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
,NCSBN TEST BANK - for the NCLEX-
RN & NCLEX-PN, UPDATED EDITION,
Complete Questions & Answers with
rationale
D) Diarrhea and poor skin turgor
Review Information: The correct answer is:B) Rash and restlessness.
,NCSBN TEST BANK - for the NCLEX-
RN & NCLEX-PN, UPDATED EDITION,
Complete Questions & Answers with
rationale
Question 4
As the nurse takes a history of a 3 year-old with neuroblastoma, what comments by the parents require
follow-up and are consistent with the diagnosis?
A) "The child has been listless and has lost weight."
B) "Her urine is dark yellow and small in amounts."
C) "Clothes are becoming tighter across her abdomen."
D+) "We notice muscle weakness and some unsteadiness."
Review Information: The correct answer is:C) "Clothes are becoming tighter across her abdomen.".
One of the most common signs of neuroblastoma is increasing abdominal girth. The parents'' report that
clothing is tight is significant, and should be followed by additional assessments.
Question 5
A 16 year-old presents to the emergency department. The triage nurse finds that this teenager is legally
married and signed the consent form for treatment. What would be the appropriate INITIAL action by the
nurse?
A) Refuse to see the client until a parent or legal guardian can be contacted
B) Withhold treatment until telephone consent can be obtained from the spouse
C) Refer the client to a community pediatric hospital emergency room
D) Assess and treat in the same manner as any adult client
Review Information: The correct answer is:D) Assess and treat in the same manner as any adult client.
Minors may become known as an "emancipated minor" through marriage, pregnancy, high school
graduation, independent living or service in the military. Therefore, this client, who is married, has the legal
capacity of an adult.
, NCSBN TEST BANK - for the NCLEX-
RN & NCLEX-PN, UPDATED EDITION,
Complete Questions & Answers with
rationale
Question 6
A newly admitted elderly client is severely dehydrated. When planning care for this client, which one of the
following is an appropriate task for an Unlicensed Assistive Personnel (UAP)?
RN & NCLEX-PN, UPDATED EDITION,
Complete Questions & Answers with
rationale
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: The correct answer is: C) Advance Directives. This document specifies 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: The correct answer 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 find 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
,NCSBN TEST BANK - for the NCLEX-
RN & NCLEX-PN, UPDATED EDITION,
Complete Questions & Answers with
rationale
D) Diarrhea and poor skin turgor
Review Information: The correct answer is:B) Rash and restlessness.
,NCSBN TEST BANK - for the NCLEX-
RN & NCLEX-PN, UPDATED EDITION,
Complete Questions & Answers with
rationale
Question 4
As the nurse takes a history of a 3 year-old with neuroblastoma, what comments by the parents require
follow-up and are consistent with the diagnosis?
A) "The child has been listless and has lost weight."
B) "Her urine is dark yellow and small in amounts."
C) "Clothes are becoming tighter across her abdomen."
D+) "We notice muscle weakness and some unsteadiness."
Review Information: The correct answer is:C) "Clothes are becoming tighter across her abdomen.".
One of the most common signs of neuroblastoma is increasing abdominal girth. The parents'' report that
clothing is tight is significant, and should be followed by additional assessments.
Question 5
A 16 year-old presents to the emergency department. The triage nurse finds that this teenager is legally
married and signed the consent form for treatment. What would be the appropriate INITIAL action by the
nurse?
A) Refuse to see the client until a parent or legal guardian can be contacted
B) Withhold treatment until telephone consent can be obtained from the spouse
C) Refer the client to a community pediatric hospital emergency room
D) Assess and treat in the same manner as any adult client
Review Information: The correct answer is:D) Assess and treat in the same manner as any adult client.
Minors may become known as an "emancipated minor" through marriage, pregnancy, high school
graduation, independent living or service in the military. Therefore, this client, who is married, has the legal
capacity of an adult.
, NCSBN TEST BANK - for the NCLEX-
RN & NCLEX-PN, UPDATED EDITION,
Complete Questions & Answers with
rationale
Question 6
A newly admitted elderly client is severely dehydrated. When planning care for this client, which one of the
following is an appropriate task for an Unlicensed Assistive Personnel (UAP)?
