NCLEX-PN Test #2

Question 1

A client with Type 2 diabetes becomes sweaty and shaky during morning care. What should the nurse do first?

Accepted Answer

Give the client a source of fast-acting sugar.

Answer

Sweating and shakiness are classic signs of hypoglycemia (low blood sugar) in a client with diabetes. The priority is to immediately administer a source of fast-acting sugar, such as juice or glucose tablets, to rapidly raise blood glucose levels. This prevents further complications and quickly alleviates the acute symptoms of hypoglycemia.

Question 2

A client prescribed furosemide reports leg cramps. Which assessment is most important?

Accepted Answer

Assess the client for possible hypokalemia.

Answer

Furosemide is a loop diuretic that promotes the excretion of potassium, among other electrolytes. Leg cramps are a common symptom of hypokalemia (low potassium levels). Therefore, assessing for hypokalemia is the most important action to identify the potential cause of the client's symptoms and guide appropriate intervention.

Question 3

The nurse is caring for a client on contact precautions. Which action is necessary?

Accepted Answer

Wear gloves and gown upon entering the room.

Answer

Contact precautions are implemented to prevent the spread of infectious agents transmitted by direct or indirect contact. Wearing gloves and a gown upon entering the room creates a barrier, preventing the nurse's skin and clothing from becoming contaminated. This is a fundamental practice to protect both the healthcare worker and other clients from pathogen transmission.

Question 4

A client receiving morphine IV develops slow respirations. What is the priority action?

Accepted Answer

Stop the opioid infusion and assess respirations.

Answer

Slow respirations are a critical sign of opioid-induced respiratory depression, which can be life-threatening. The priority action is to immediately stop the opioid infusion to prevent further central nervous system depression. This allows the nurse to assess the client's respiratory status without additional medication contributing to the problem, and then intervene as needed.

Question 5

Which sign indicates that a client with pneumonia is improving?

Accepted Answer

Increased oxygen saturation and reduced coughing.

Answer

Pneumonia impairs gas exchange in the lungs, leading to decreased oxygen saturation and often increased coughing as the body tries to clear secretions. As a client improves, their lungs become clearer, leading to better oxygenation (increased oxygen saturation) and a reduction in the inflammatory response and mucus production (reduced coughing). These are direct indicators of resolving infection and improved respiratory function.

NCLEX Practice Test

NCLEX Practice Test

NCLEX-PN Test #2