NCSBN NCLEX TEST BANK 2 LATEST 2025 WITH 150

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NCSBN NCLEX TEST BANK 2 LATEST 2025 WITH 150

REAL EXAM PREP QUESTIONS AND CORRECT

ANSWERS WITH RATIONALES | N CSBN NCLEX TEST

BANK 2 2025 /RN NCLEX EXAM PREP 2025 (NEWEST!)

The nurse has an order to insert an indwelling urinary catheter for a male client.What is the best reason for lubricating the tip of the catheter prior to insertion?

• Reduce the friction within the urethra
• Diminish the leakage of urine around the catheter
• Minimize risk for infection
• Prevent bladder distention

A Due to the somewhat long length of the male urethra, lubrication reduces potential discomfort and localized tissue irritation as the catheter is passed.The nurse is teaching the parents of a child with sickle cell disease about ways to prevent complications and crises. What information would be a priority for the nurse to emphasize to the family?

• The child may not be able to follow routine immunization schedules
• The child should avoid becoming overheated or dehydrated during physical

activity and exercise

• The child can maintain normal activity with some restrictions
• The child should be cautious of being exposed to people with a cold or fever

B The goal of sickle cell treatment is to manage and control symptoms and to prevent sickle cell crisis. Fluid loss caused by overheating and dehydration can trigger a sickle cell crisis. People with sickle cell anemia need to keep their immunizations up-to-date, treat infections quickly, and avoid too much sun exposure.A 10-month old infant is admitted with a diagnosis of bacterial meningitis. Several hours after admission, during a planning conference, which of the actions suggested to the registered nurse (RN) by the practical nurse (PN) would be appropriate to add to the plan of care? 1 / 4

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• Provide an over-the-crib protective top
• Measure head circumference
• Initiate droplet precautions
• Provide passive range of motion

B In meningitis, assessment of neurological signs should be done frequently. Head circumference is measured because subdural effusions and obstructive hydrocephalus can develop as a complication of meningitis. The client would have already been placed on droplet precautions and had a crib top applied to the bed when he was admitted to the unit.A client asks the nurse about including her 2 year-old and 12 year-old sons in the care of their newborn sister. Which response is an appropriate initial statement by the nurse?

• "Focus on your sons' needs during the first days at home."
• "Suggest that your partner spend more time with the boys."
• "Tell each child what he can do to help with the baby."
• "Ask the children what they would like to do for the newborn."

A In an expanded family, it is important for parents to reassure older children that they are loved and as important as the newborn.The nurse is caring for a client who is exhibiting a panic attack. What should the nurse do for this client?

• Assist the client to describe the experience in detail
• Develop a trusting relationship
• Maintain safety for the client
• Teach the client to control behaviors

C Clients who display signs of severe anxiety in the form of a panic attack need to be supervised closely until the anxiety is lessened. They may harm themselves or others because during panic attacks perception is narrowed and thinking is flawed. 2 / 4

pg. 3 The nurse is to review the topic of caring for clients with Guillain-Barré syndrome with other staff members at a monthly meeting. Which of these findings should the nurse include in the discussion? (Select all that apply.)

• Weakness, tingling or loss of sensation in legs and feet occur first
• Rapidly progressive ascending paralysis of the legs, arms, respiratory muscles

and face

• Difficulty with bladder control or intestinal functions
• Hypertension
• Difficulty with eye movement, facial movement, speaking, chewing or

swallowing

• Numbness, tingling, prickling sensation or moderate pain throughout the body

A,B,C,E,F

Guillian-Barré is an autoimmune disease. The symptoms of weakness or tingling sensation begins in the legs and progresses to the arms and upper body, resulting in almost complete paralysis. The client is often put on a ventilator during the worst part of the disease to assist breathing. The client may have low blood pressure or poor blood pressure control.A 1 year-old child is receiving temporary total parental nutrition (TPN) through a central venous line. This is the first day of TPN therapy. Although all of the following nursing actions must be included in the plan of care of this child, which one would be a priority at this time?

• Use aseptic technique during dressing changes
• Check results of liver enzyme tests
• Maintain central line catheter integrity
• Monitor serum glucose levels

D Hyperglycemia may occur during the first day or two as the child adapts to the high-glucose load of the TPN solution. Thus, a priority nursing responsibility is blood glucose testing.The nurse is teaching diet restrictions to a client diagnosed with Addison's disease.The client indicates an understanding of the dietary restrictions when making which of these statements?

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• "I will increase fluids and restrict sodium and potassium."
• "I will increase sodium and fluids and restrict potassium."
• "I will increase sodium, potassium and fluids."
• "I will increase potassium and sodium and restrict fluids."

B The manifestations of Addison's disease (also called adrenal insufficiency or hypocortisolism) are due to mineralocorticoid deficiency that results in renal sodium wasting and potassium retention. Other findings are dehydration, hypotension, hyponatremia, hyperkalemia and metabolic acidosis.A nurse is working in an inpatient psychiatric setting. The nurse understands what reason touching clients should be limited to a quick handshake?

• A handshake allows the use of therapeutic touch while maintaining boundaries.
• Touching a client, other than a handshake, can set off a violent episode.
• Refraining from touching signals the termination of the nurse-client

relationship.

• A handshake will not be misinterpreted as an invitation to more sexual

behavior.A The therapeutic use of touch is a basic part of the nurse-client relationship.However, in a psychiatric setting, the extent of physical contact should be limited to handshakes. Some facilities may even have a no-touch policy, especially when working with clients who have a history of sexual trauma. Even reassuring touching can be misinterpreted by the client.Upon completion of the admission documents, the nurse identifies that an elderly client does not have an advance directive. What action should the nurse take?

• Document this information on the chart
• Refer this issue to the nurse manager and the risk manager
• Give the client written information about advance directives
• Assume that the client wishes full resuscitation efforts

C For each admission, nurses should request a copy of a client's current advance directive. If there is none, the nurse must provide written information about what an advance directive implies. It is then the client's choice to sign the forms. Note

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