NCLEX-PN Test #4 2 — Questions and Answers
Question 1: A client with active pulmonary tuberculosis is admitted to the hospital. Which type of isolation precautions should the nurse implement?
- Contact precautions
- Droplet precautions
- Airborne precautions with negative pressure room (Correct answer)
- Standard precautions only
Correct answer: Airborne precautions with negative pressure room
Active pulmonary TB is transmitted via airborne droplet nuclei (small particles that remain suspended in air). Airborne precautions require a negative-pressure room, N95 respirator (not surgical mask) for staff, and keeping the door closed. Droplet precautions are for larger droplets (influenza, pertussis).
Question 2: The PN is performing a well-child visit for an 18-month-old. Which developmental milestone is expected at this age?
- Uses 50+ words and speaks in 2-word phrases
- Walks independently and uses 10–20 words (Correct answer)
- Rides a tricycle and draws a circle
- Hops on one foot and knows full name
Correct answer: Walks independently and uses 10–20 words
By 18 months, a child should walk independently without support and have a vocabulary of approximately 10–20 words. Two-word phrases typically develop by 24 months. Tricycle riding is a 3-year milestone; hopping on one foot develops around age 4.
Question 3: During a home visit, the PN observes an elderly client with multiple unexplained bruises in various stages of healing. What is the nurse's priority action?
- Ask the family caregiver to explain the bruises
- Document observations and report suspected elder abuse to the appropriate authority (Correct answer)
- Arrange for the client to be admitted to a nursing facility
- Give the client a phone number for adult protective services
Correct answer: Document observations and report suspected elder abuse to the appropriate authority
Multiple bruises in various stages of healing are a classic indicator of elder abuse. The PN is a mandated reporter and must document objective findings and report to the designated authority (adult protective services or state agency). Confronting the caregiver directly can escalate danger for the client.
Question 4: Which hand hygiene technique is most effective for preventing the spread of Clostridioides difficile (C. diff) spores?
- Alcohol-based hand rub for 15 seconds
- Soap and water handwashing for at least 20 seconds (Correct answer)
- Chlorhexidine-based hand rub
- Waterless antiseptic foam
Correct answer: Soap and water handwashing for at least 20 seconds
C. difficile forms spores that are NOT killed by alcohol-based hand sanitizers. Soap and water with vigorous friction for at least 20 seconds is required to physically remove spores from the hands. This is a critical distinction from most other pathogens where alcohol rub is equally effective.
Question 5: The PN is educating a community group about colorectal cancer screening. At what age should average-risk adults begin routine screening?
- 40 years
- 45 years (Correct answer)
- 50 years
- 55 years
Correct answer: 45 years
Current guidelines (ACS 2018, USPSTF 2021) recommend colorectal cancer screening beginning at age 45 for average-risk adults. This was lowered from 50 due to rising incidence in younger populations. Higher-risk individuals (family history, IBD) should begin earlier.
Question 6: A community health nurse is educating clients about primary prevention of type 2 diabetes. Which intervention is an example of primary prevention?
- Screening asymptomatic adults with fasting blood glucose
- Teaching foot care to a client with established diabetes
- Promoting weight loss and physical activity in at-risk populations (Correct answer)
- Referring a pre-diabetic client to a diabetes education program
Correct answer: Promoting weight loss and physical activity in at-risk populations
Primary prevention aims to prevent disease before it occurs by reducing risk factors. Promoting weight loss and physical activity in at-risk populations targets modifiable risk factors for type 2 diabetes. Screening is secondary prevention; education for established or pre-diabetic clients is tertiary/secondary prevention.
NCLEX-PN Test #4 2
A client with active pulmonary tuberculosis is admitted to the hospital.
Which type of isolation precautions should the nurse implement?