NCLEX PN Test
Question 1 of 5.
The nurse has attended a staff education program about ethical practices in nursing. Which of the following statements by the nurse would indicate a correct understanding of the program? Select all that apply.
A. Accountability is notifying the health care provider after making a medication error.
B. Autonomy is informing the client of the care decisions the family has made for the client.
C. Confidentiality is respecting a client's request to keep suicidal ideation a secret from other members of the health care team.
D. Fidelity is returning to the client's room with pain medication at the time that was promised to the client.
E. Nonmaleficence is reporting suspected elder abuse of a client with Alzheimer disease.
Explanation: Accountability involves taking responsibility for errors (A). Fidelity is keeping promises, such as timely medication delivery (D). Nonmaleficence includes preventing harm by reporting abuse (E). Autonomy respects the client's decision-making, not family decisions (B), and confidentiality does not extend to withholding suicidal ideation, which requires intervention (C).
Question 2 of 5.
The nurse is caring for a woman who is HIV positive. The woman starts her period. There is menstrual blood on the floor. What substance should the nurse use to clean up the floor?
A. Chlorine bleach
B. Hydrogen peroxide
C. Betadine
D. Ammonia
Explanation: Chlorine bleach is the best product for cleaning blood spills, as HIV can be present in menstrual blood, requiring a disinfectant effective against bloodborne pathogens.
Question 3 of 5.
A client is admitted with right lower quadrant pain, nausea, and a temperature of 100°F. What does the nurse expect will be done initially?
A. X-ray of the abdomen
B. Deep palpation of the abdomen
C. Blood drawn for complete blood count (CBC)
D. Administration of a tap water enema
Explanation: Symptoms suggest appendicitis; a CBC is initial to assess for infection (elevated WBC), guiding further diagnostic steps.
Question 4 of 5.
The nurse is caring for an adult who was admitted for observation following an automobile accident. The client has several lacerations that were sutured in the emergency room and a fractured leg that has been casted. The baseline vital signs are BP=120/72, P=76, and R=16. One hour after arriving on the unit, the client's vital signs are BP=108/68, P=90, and R=22. The nurse most correctly interprets these results to mean that the client may be developing which condition?
A. Shock
B. Increased intracranial pressure
C. Panic attack
D. Autonomic hyperreflexia
Explanation: Decreased BP, increased pulse, and respirations suggest shock, possibly from occult bleeding or trauma response, requiring urgent evaluation.
Question 5 of 5.
The nurse is caring for a client who is scheduled for a cardiac stress test tomorrow. Prior to the stress test, the nurse should:
A. encourage the client to eat a hearty meal just before the test.
B. not give the client caffeine to drink.
C. have the client practice by walking vigorously around the unit.
D. not let the client watch stressful programs on television.
Explanation: Caffeine can affect heart rate and test results, so it should be avoided before a stress test.
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