NCLEX-PN Exam Pack Part 4

NCLEX-PN Exam Pack Part 4 Updated 2022 1.1. Question A client has returned to his room following an esophagoscopy. Before offering fluids, the nurse

should give priority to assessing the client’s:

 A. Level of consciousness  B. Movement of extremities  C. Urinary output  D. Gag reflex

Correct Answer: D. Gag reflex

Option D: The client’s gag reflex is

depressed before having an EGD. The nurse should give priority to checking for the return of the gag reflex before offering the client oral fluids.

Option A: Conscious sedation is used.

Options B and C: Movements of extremities

and urinary output are not affected by the procedure.2. Question Which instruction should be included in the discharge teaching for the client with cataract surgery? A. Over-the-counter eye drops can be used to treat redness and irritation

 B. The eye shield should be worn at night  C. It will be necessary to wear special cataract glasses  D. A prescription for medication to control post-operative pain will be needed

Correct Answer: B. The eye shield should be

worn at night

Option B: The eye shield should be worn at

night or when napping, to prevent accidental trauma to the operative eye.

Option A: Prescription eye drops, not over-

the-counter eye drops, are ordered for the client.

Option C: The client might or might not

require glasses following cataract surgery.

Option D: Cataract surgery is pain-free.

3. Question An 8-year-old is admitted with a sore throat, drooling, muffled phonation, high pitched-sound upon breathing (stridor), and a temperature of 102°F. The nurse should immediately notify the doctor because the

child’s symptoms are suggestive of:

 A. Primary Ciliary Dyskinesia  B. Subglottic hemangioma  C. Sinusitis  D. Epiglottitis

Correct Answer: D. Epiglottitis

Option D: The child’s symptoms are

consistent with those of epiglottitis, an

infection of the upper airway that can result in total airway obstruction.

Option A: Primary ciliary dyskinesia is a rare

lung disease that is caused by a defect in cilia (hair-like projections that are responsible for expelling foreign materials such as mucous) resulting in respiratory problems such as excessive mucus, chronic wheezing, cough, and nasal congestion.

Option B: Subglottic hemangioma is the

formation of large masses in the airway causing airway obstructions. Typically symptoms include croup-like cough, difficulty breathing, and stridor.

Option C: Sinusitis is the inflammation of

the tissue that lines the sinuses that cause postnasal drip, runny nose, pain, and tenderness around the face, and nasal congestion.4. Question Phototherapy is ordered for a newborn with physiologic jaundice. The nurse caring for the infant

should:

 A. Place the baby on enteric isolation  B. Apply lotion, or oil on the baby’s skin to prevent drying  C. Wear a gown, gloves, and a mask while caring for the infant  D. Encourage the mother to continue breastfeeding

Correct Answer: D. Encourage the mother to

continue breastfeeding

Option D: Breastfeeding will improve the

nutrition of the newborn and will help in

eliminating excess bilirubin (the main cause of physiological jaundice).

Option B: The use of lotion and oils while on

phototherapy is not advisable since it may cause skin burn.

Options A and C: Physiologic jaundice is not

associated with infection.  5. Question A teen hospitalized with anorexia nervosa is now permitted to leave her room and eat in the dining room. Which of the following nursing interventions should be included in the client’s plan of care? A. Weighing the client after she eats  B. Having a staff member remain with her for 1 hour after she eats  C. Placing high-protein foods in the center of the client’s plate  D. Providing the client with child-size utensils

Correct Answer: B. Having a staff member

remain with her for 1 hour after she eats

Option B: Having a staff member remain

with the client for 1 hour after meals will help prevent the incidence of self-induced vomiting.

Option A: The client will weigh more after

meals, which can undermine treatment.

Option C: The client will need a balanced

diet and excess protein might not be well tolerated at first.

Option D: Giving child-size utensils treats

the client as a child rather than as an adult.6. Question