NCLEX Select All That Apply Practice Exam 8

Question 1

The clinic nurse is assisting to perform a focused data collection process on a client who is complaining of symptoms of a cold, a cough, and lung congestion.
Which of the following would the nurse include for this type of data collection? Select all that apply.

Accepted Answer

Auscultating lung sounds

Answer

Checking the strength of peripheral pulses

Answer

Performing a musculoskeletal and neurological examination

Answer

Asking the client about a family history of any illness or disease

Question 2

A community health nurse is conducting a teaching session about terrorism with members of the community and discussing information regarding anthrax. The nurse tells those attending that anthrax can be transmitted via which route(s)? Select all that apply.

Accepted Answer

Skin

Answer

Kissing

Answer

Direct contact with an infected individual

Answer

Sexual contact with an infected individual

Question 3

The emergency room nurse is providing discharge teaching to the parents of a 2-year-old child who sustained burns from a hot cup of coffee that had been left on the kitchen counter. The nurse evaluates that the parents have correctly understood the teaching when they state which of the following?

Accepted Answer

"We will be sure to not leave hot liquids unattended."

Answer

"I guess my child needs to understand what the word 'hot' means."

Answer

"We will be sure that our child stays in his room when we work in the kitchen."

Answer

"We will install a safety gate as soon as we get home so that our child can't get into the kitchen."

Question 4

A licensed practical nurse is attending an agency orientation meeting about the nursing model of practice implemented in the facility. The nurse is told that the nursing model is a team nursing approach. The nurse understands that which of the following is a characteristic of this type of nursing model of practice?

Accepted Answer

Nursing staff are led by a nurse when providing care to a group of clients.

Answer

A task approach method is used to provide care to clients.

Answer

Managed care concepts and tools are used when providing client care.

Answer

A single registered nurse is responsible for providing nursing care to a group of clients.

Question 5

A licensed practical nurse is planning the client assignments for the day. Which of the following is the most appropriate assignment for the nursing assistant?

Accepted Answer

A client who requires frequent ambulation

Answer

A client who requires wound irrigation

Answer

A client who is receiving continuous tube feedings

Answer

A client who requires frequent vital signs after a cardiac catheterization

Question 6

A male client who has heart failure receives an additional dose of bumetanide as prescribed 4 hours after the daily dose. The nurse assesses him 15 minutes after administering the medication and reminds him to save all urine in the bathroom. Thirty minutes later the nurse finds the client on the floor, unresponsive, and bleeding from a laceration. Determine the issues that support the client's malpractice claim. Select all that apply.

Accepted Answer

Increased risk of hypotension

Answer

Failure to replace body fluids

Answer

Excessive bumetanide administration

Question 7

A nurse develops a plan of care for a client following a lumbar puncture. Which interventions should be included in the plan? Select all that apply.

Accepted Answer

Monitor the client's ability to void.

Answer

Restrict fluid intake for a period of 2 hours.

Answer

Maintain the client on a nothing-by-mouth (NPO) status for 24 hours.

Question 8

A nurse employed in an emergency department is assigned to assist with the triage of clients arriving to the emergency department for treatment on the evening shift. The nurse would assign the highest priority to which of the following clients?

Accepted Answer

A client with chest pain who states that he just ate pizza that was made with a very spicy sauce

Answer

A client complaining of muscle aches, a headache, and malaise

Answer

A client who twisted her ankle when she fell while rollerblading

Answer

A client with a minor laceration on the index finger sustained while cutting an eggplant

Question 9

A nurse enters a client's room and notes that the client's lawyer is present and that the client is preparing a living will. The living will requires that the client's signature be witnessed, and the client asks the nurse to witness the signature. Which of the following is the appropriate nursing action?

Accepted Answer

Decline to sign the will.

Answer

Sign the will as a witness to the signature only.

Answer

Call the hospital lawyer before signing the will.

Answer

Sign the will, clearly identifying credentials and employment agency.

Question 10

The nurse is caring for a client who is unconscious following a fall. Which comment by the nurse will help the client become reoriented when he regains consciousness?

Accepted Answer

“You were in an accident that hurt your head. You are in the hospital.”

Answer

“I am your nurse and I will be taking care of you today.”

Answer

“Can you tell me your name and where you are?”

Answer

“I know you are confused right now, but everything will be alright.”

The clinic nurse is assisting to perform a focused data collection process on a client who is complaining of symptoms of a cold, a cough, and lung congestion.Which of the following would the nurse include for this type of data collection? Select all that apply.

The clinic nurse is assisting to perform a focused data collection process on a client who is complaining of symptoms of a cold, a cough, and lung congestion.
Which of the following would the nurse include for this type of data collection? Select all that apply.