NCLEX RN Practice Test Flashcards
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Questions and Answers

What should the nurse do next when an unemancipated minor requests treatment?

  • Triage after guardian consent obtained
  • Ask minor about the medical reason for seeking treatment (correct)
  • Notify nursing supervisor
  • Request HCP perform medical screening exam
  • What is the most appropriate response by the nurse when an LPN assigned to a client with localized herpes zoster states they have never had chickenpox?

  • Use standard precautions when caring for this patient
  • You will be fine; airborne precautions needed
  • Why are you concerned about providing care for this patient?
  • Your client assignment will be changed (correct)
  • Which client should the nurse see first?

  • 6 weeks gestation, LPN can't get fetal heart tones with Doppler
  • 22 weeks gestation, feels fetal movement 4 times per hour
  • 2 days postpartum, has urinary incontinence
  • 5 days postpartum, bright red bloody discharge (correct)
  • What statements should the nurse include when responding to a patient concerned about a bone marrow aspiration and biopsy?

    <p>A tight pressure dressing will be placed over the test site after the procedure</p> Signup and view all the answers

    What is the best response by the nurse when a spouse states, 'You never take any responsibility for the messes you always cause'?

    <p>Blaming is not effective</p> Signup and view all the answers

    Which actions should the nurse include in the plan of care for a patient with a gastrostomy tube?

    <p>Rotate gastrostomy tube 360 degrees once daily</p> Signup and view all the answers

    Which statement made by the patient is most concerning regarding potential spousal abuse?

    <p>It's my fault because I push my spouse's buttons</p> Signup and view all the answers

    Study Notes

    ED Triage and Unemancipated Minor

    • Unemancipated minors may consent to treatment for certain medical conditions such as pregnancy, STIs, substance abuse, and mental health issues.
    • The nurse should first assess the minor's medical reason for seeking treatment before any further actions.

    Caring for Clients with Localized Herpes Zoster

    • Localized herpes zoster (shingles) poses a risk of exposing unvaccinated individuals to chickenpox.
    • Standard precautions are crucial, and potential changes in assignments may be necessary based on staff concerns regarding exposure risks.

    Prioritizing Pregnant and Postpartum Patients

    • Bloody discharge (rubra lochia) in postpartum patients should last only 1-3 days; any bright red discharge after 5 days is concerning.
    • Fetal heart tones cannot be detected until at least 8-12 weeks gestation, and less than 3 fetal movements in an hour may indicate concern for fetal wellbeing.

    Bone Marrow Aspiration and Biopsy

    • Bone marrow aspiration can be performed in the patient’s room, not exclusively in an OR setting.
    • A tight pressure dressing is important after the procedure to manage potential bleeding, and monitoring for bleeding post-test is essential.
    • Patients may feel discomfort during local anesthetic injection, which should be communicated prior to the procedure.

    Couples Counseling Dynamics

    • Blame can be counterproductive in relationship discussions; addressing communication patterns can be more effective.
    • Statements that suggest one partner feels solely responsible may indicate deeper issues in communication and relationship dynamics.

    Enteral Feedings through Gastrostomy Tube

    • The insertion site should be covered with a sterile bandage initially to prevent infections.
    • Only 4 hours of formula should be added at a time to minimize the risk of bacterial growth in the feeding bag.
    • Daily rotation of the gastrostomy tube helps prevent skin irritation, while slight movement indicates that the tube is properly placed.

    Assessing for Potential Spousal Abuse

    • Victims of spousal abuse often express self-blame, which can be a red flag for ongoing abuse.
    • Statements indicating unhappiness and disputes in the relationship may also require further assessment, but direct blame is of the highest concern.

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    Test your knowledge with this NCLEX RN practice test featuring essential scenarios and questions at the passing level. Perfect for nursing students preparing for the exam. Each flashcard is designed to help reinforce your understanding of critical nursing concepts.

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