NCLEX NCLEX Certifications NCLEX-PN Questions & Answers

• Question 211:

  Which of the following terms refers to soft-tissue injury caused by blunt force?

  A. contusion

  B. strain

  C. sprain

  D. dislocation

  Correct Answer: A

  A contusion is a soft-tissue injury caused by blunt force. It is an injury that does not break the skin, is caused by a blow and is characterized by swelling, discoloration, and pain. The immediate application of cold might limit the development of a contusion.

  A strain is a muscle pull from overuse, overstretching, or excessive stress.

  A sprain is caused by a wrenching or twisting motion.

  A dislocation is a condition in which the articular surfaces of the bones forming a joint are no longer in

  anatomic contact.

• Question 212:

  Why must the nurse be careful not to cut through or disrupt any tears, holes, bloodstains, or dirt present on the clothing of a client who has experienced trauma?

  A. The clothing is the property of another and must be treated with care.

  B. Such care facilitates repair and salvage of the clothing.

  C. The clothing of a trauma victim is potential evidence with legal implications.

  D. Such care decreases trauma to the family members receiving the clothing.

  Correct Answer: C

  Trauma in any client, living or dead, has potential legal and/or forensic implications.

  Clothing, patterns of stains, and debris are sources of potential evidence and must be preserved. Nurses

  must be aware of state and local regulations that require mandatory reporting of cases of suspected child

  and elder abuse, accidental death, and suicide.

  Each Emergency Department has written policies and procedures to assist nurses and other health care

  providers in making appropriate reports.

  Physical evidence is real, tangible, or latent matter that can be visualized, measured, or analyzed.

  Emergency Department nurses can be called on to collect evidence.

  Health care facilities have policies governing the collection of forensic evidence. The chain of evidence

  custody must be followed to ensure the integrity and credibility of the evidence. The chain of evidence

  custody is the pathway that evidence follows from the time it is collected until has served its purpose in the

  legal investigation of an incident.

• Question 213:

  Which of the following injuries, if demonstrated by a client entering the Emergency Department, is the highest priority?

  A. open leg fracture

  B. open head injury

  C. stab wound to the chest

  D. traumatic amputation of a thumb

  Correct Answer: C

  A stab wound to the chest might result in lung collapse and mediastinal shift that, if untreated, could lead to

  death.

  Treatment of an obstructed airway or a chest wound is a higher priority than hemorrhage.

  The principle of ABC (airway, breathing, and circulation) prioritizes care decisions.

• Question 214:

  A client comes to the clinic for assessment of his physical status and guidelines for starting a weight-reduction diet. The client's weight is 216 pounds and his height is 66 inches.

  The nurse identifies the BMI (body mass index) as __________.

  A. within normal limits, so a weight-reduction diet is unnecessary

  B. lower than normal, so education about nutrient-dense foods is needed

  C. indicating obesity because the BMI is 35

  D. indicating overweight status because the BMI is 27

  Correct Answer: C

  Obesity is defined by a BMI of 30 or more with no co-morbid conditions. It is calculated by utilizing a chart

  or nomogram that plots height and weight.

  This client's BMI is 35, indicating obesity.

  Goals of diet therapy are aimed at decreasing weight and increasing activity to healthy levels based on a

  client's BMI, activity status, and energy requirements.

• Question 215:

  When a client informs the nurse that he is experiencing hypoglycemia, the nurse provides immediate intervention by providing __________.

  A. one commercially prepared glucose tablet

  B. two hard candies

  C. 4-6 ounces of fruit juice with 1 teaspoon of sugar added

  D. 2-3 teaspoons of honey

  Correct Answer: D

  The usual recommendation for treatment of hypoglycemia is 10-15 grams of a fast-acting simple carbohydrate, orally, if the client is conscious and able to swallow (for example, 3-4 commercially prepared glucose tablets or 4-6 oz of fruit juice). It is not necessary to add sugar to juice, even if it is labeled as unsweetened juice because the fruit sugar in juice contains enough simple carbohydrate to raise the blood glucose level. Addition of sugar might result in a sharp rise in blood sugar that could last for several hours.

• Question 216:

  Acyclovir is the drug of choice for __________.

  A. HIV

  B. HSV 1 and 2 and VZV

  C. CMV

  D. influenza A viruses

  Correct Answer: B

  Acyclovir (Zovirax) is specific for treatment of herpes virus infections. There is no cure for herpes.

  Acyclovir is excreted unchanged in the urine and therefore must be used cautiously in the presence of

  renal impairment.

  Drugs that treat herpes inhibit viral DNA replication by competing with viral substrates to form shorter,

  ineffective DNA chains.

• Question 217:

  The nurse teaching about preventable diseases should emphasize the importance of getting the following vaccines __________.

  A. human papilloma virus, genital herpes, measles

  B. pneumonia, HIV, mumps

  C. syphilis, gonorrhea, pneumonia

  D. polio, pertussis, measles

  Correct Answer: D

  Vaccines are one of the most effective methods of preventing and controlling certain communicable diseases. The smallpox vaccine is not currently in use because the smallpox virus has been declared eradicated from the world's population. Diseases such as polio, diphtheria, pertussis, and measles are mostly controlled by routine childhood immunization. They have not, however, been eradicated, so children need to be immunized against these diseases.

  Exam I

• Question 218:

  Teaching the client with gonorrhea how to prevent reinfection and further spread is an example of __________.

  A. primary prevention

  B. secondary prevention

  C. tertiary prevention

  D. primary health care prevention

  Correct Answer: B

  Secondary prevention targets the reduction of disease prevalence and disease morbidity through early diagnosis and treatment.

• Question 219:

  Which of the following is likely to increase the risk of sexually transmitted disease?

  A. alcohol use

  B. certain types of sexual practices

  C. oral contraception use

  D. all of the above

  Correct Answer: D

  STDs affect certain groups in groups in greater numbers.

  Factors associated with risk include being younger than 25 years of age, being a member of a minority

  group, residing in an urban setting, being impoverished, and using crack cocaine.

• Question 220:

  Which of the following medications is a serotonin antagonist that might be used to relieve nausea and vomiting?

  A. metoclopramide (Reglan)

  B. onedansetron (Zofran)

  C. hydroxyzine (Vistaril)

  D. prochlorperazine (Compazine)

  Correct Answer: B

  Zofran is a serotonin antagonist that can be used to relieve nausea and vomiting.

  The other medications can be used for nausea and vomiting, but they have different mechanisms of

  action.