NCLEX PN Practice Questions
Question 1 of 5.
The nurse is talking with a female client about collecting a clean-catch urine specimen. Which of the following information should the nurse include? Select all that apply.
A. Avoid touching the inside of the specimen container.
B. Position the specimen container before initiating your stream of urine.
C. Cleanse your vulva from front to back with single-use antiseptic towelettes.
D. Spread your labia using your nondominant hand before cleansing your perineum and urinating.
E. Remove the lid from the specimen container and place it on the counter with the sterile side facing down.
Explanation: Avoiding contamination, proper cleansing, and spreading the labia are critical for a clean-catch specimen. The lid should be placed sterile side up, and the container should be positioned midstream.
Question 2 of 5.
The nurse is caring for a woman who is admitted for a hysterectomy. The woman does not speak English. No staff members speak the client's language. Which approach by the nurse would be most appropriate when communicating with the client about her care before and after the surgery?
A. Ask the woman's 8-year-old daughter who speaks English to interpret.
B. Draw pictures and gesture when speaking to the client.
C. Speak very slowly when giving the client instructions.
D. Request an interpreter from social services.
Explanation: The nurse should request an interpreter from social services to ensure accurate communication. Using a child to interpret is inappropriate due to medical terminology and privacy concerns. Pictures, gestures, or slow speech in English are insufficient for surgical care discussions.
Question 3 of 5.
The nurse is caring for a client who has been in alcohol detoxification for one week. The client has slurred speech and is bumping into doorframes and walking unsteadily. What is the most appropriate initial action by the nurse?
A. Assess for Wernicke-Korsakoff syndrome
B. Ask for an order for blood alcohol level
C. Request a neurology consult
D. Administer a PRN dose of diazepam (Valium)
Explanation: Slurred speech and unsteady gait post-detox may indicate Wernicke-Korsakoff syndrome, a thiamine deficiency complication, requiring urgent assessment.
Question 4 of 5.
An adult who is scheduled for surgery tomorrow asks the nurse to arrange for his Healing Touch practitioner to give him healing touch treatments after surgery. The client's daughter who hears the request asks the nurse to explain how Healing Touch can help her father. What information should the nurse include in the response?
A. Healing Touch makes use of the power of suggestion and can help the person feel more comfortable.
B. No one really knows how it works, but if a person really wants it, it certainly will not hurt.
C. The Healing Touch practitioner works within the energy field around the person to facilitate healing and pain relief.
D. Healing Touch is similar to acupuncture except that pressure is used instead of needles.
Explanation: Healing Touch involves manipulating the energy field to promote healing and pain relief, a recognized complementary therapy.
Question 5 of 5.
An adult is hospitalized following a myocardial infarction. While the client is receiving heparin, the nurse should have which of the following medications available?
A. Aspirin
B. Calcium gluconate
C. Vitamin K
D. Protamine sulfate
Explanation: Protamine sulfate is the antidote for heparin overdose, reversing its anticoagulant effects in case of bleeding.
Related Questions