2
HURST REVIEW NCLEX-RN Readiness Exam 2 with accurate || || || || || || || ||
detailed solutions ||
The public health nurse is planning to participate in local forums regarding the placement
|| || || || || || || || || || || || || ||
of a factory that is known to produce pollution through discharge of chemical by-products
|| || || || || || || || || || || || || ||
into the air. What actions demonstrate ethical nursing practice in the public health arena? -
|| || || || || || || || || || || || || || ||
✔✔1. Speaking up for the underrepresented, such as the poor and uneducated persons
|| || || || || || || || || || || ||
|| 3. Requesting that forums be held throughout the community at various times of the day or
|| || || || || || || || || || || || || || ||
|| evening.
|| 4. Asking for information regarding the health status of people in other factory locations.
|| || || || || || || || || || || || ||
5. Requesting information from individuals in areas where the factories are currently
|| || || || || || || || || || || || ||
located.
Which assignment would be most appropriate for the charge nurse to assign to the LPN/VN
|| || || || || || || || || || || || || ||
in the Labor, Delivery, Recovery and Postpartum Unit (LDRP)? - ✔✔1. Primipara needing
|| || || || || || || || || || || || || ||
assistance with breastfeeding. || || ||
3. Primipara who is two days post op cesarean section.
|| || || || || || || || ||
A nurse is calling the primary healthcare provider about a client who is experiencing
|| || || || || || || || || || || || || ||
dyspnea and chest pain two days post total knee replacement. Which statements by the
|| || || || || || || || || || || || || ||
nurse are appropriate according to the communication tool SBAR (Situation, Background,
|| || || || || || || || || || ||
Assessment and Recommendation)? - ✔✔2. "Jane Doe is having increasing dyspnea and is
|| || || || || || || || || || || || ||
reporting chest pain." || ||
3. "Jane Doe had a total knee replacement two days ago. Pulse is 120, BP 128/54, Resp 32.
|| || || || || || || || || || || || || || || || || || ||
She is restless."|| ||
4. "From my assessment, I think she may be having a cardiac event or a pulmonary
|| || || || || || || || || || || || || || || || ||
embolism."
5. "I recommend that you see the client immediately and that we start oxygen stat. Do you
|| || || || || || || || || || || || || || || || || ||
agree?"
,2
Which tasks would be appropriate for the nurse to assign to an LPN/VN? - ✔✔1. Changing
|| || || || || || || || || || || || || || || ||
a colostomy bag.
|| ||
|| 2. Administer antibiotic via intravenous piggyback (IVPB).
|| || || || || ||
5. Check for urinary retention.
|| || || ||
|| 6. Remove wound sutures.
|| || ||
A 13 year old, found unresponsive in the park, is brought into the emergency department.
|| || || || || || || || || || || || || || ||
The nurse sees a medical alert bracelet stating "Diabetic", and notes a fruity smell to the
|| || || || || || || || || || || || || || || ||
breath. There are no family members available to obtain consent for treatment and an
|| || || || || || || || || || || || || ||
attempt to call them has been unsuccessful. What action should the nurse take? - ✔✔2.
|| || || || || || || || || || || || || || ||
Begin treatment by inserting two large bore IVs of Normal Saline.
|| || || || || || || || || ||
The nurse is working at the triage station. Which client should the nurse triage first? - ✔✔2.
|| || || || || || || || || || || || || || || ||
A client with a cast on the right leg who states, "My right leg is killing me and nothing I do
|| || || || || || || || || || || || || || || || || || || || || ||
makes it stop hurting. " || || || ||
A quality assurance (QA) manager plans to evaluate performance improvement regarding
|| || || || || || || || || || ||
the implementation of fall precautions for at risk clients. What steps should the QA
|| || || || || || || || || || || || || ||
manager include in this evaluation? - ✔✔1. Chart review for fall precaution documentation.
|| || || || || || || || || || || ||
|| 2. Direct observation of unit staff.
|| || || || ||
4. Identify at risk clients on unit.
|| || || || || ||
|| 5. Make unannounced visits to the unit for evaluating staff performance.
|| || || || || || || || || ||
The nurse is performing the admission assessment on a client who is having a breast
|| || || || || || || || || || || || || || ||
augmentation. Which client information would be most important for the nurse to report to || || || || || || || || || || || || ||
the surgeon before surgery? - ✔✔3. Client's last menstrual period was 8 weeks ago.
|| || || || || || || || || || || || || ||
The charge nurse has received report from the emergency department about a client
|| || || || || || || || || || || || ||
diagnosed with Cushing's disease being admitted to the unit. Which client in a semi-private
|| || || || || || || || || || || || || ||
, 2
room would be appropriate for the charge nurse to have this client share? - ✔✔3. Client
|| || || || || || || || || || || || || || || ||
who has a fractured hip.
|| || || ||
Which pediatric client should the nurse see first? - ✔✔3. Three year old with wheezes in
|| || || || || || || || || || || || || || || ||
right lower lobe. || ||
What is priority for the nurse to determine about a client who is scheduled for a tubal
|| || || || || || || || || || || || || || || || ||
ligation in the outpatient surgical center? - ✔✔3. Client's plan for transportation and care at
|| || || || || || || || || || || || || ||
home.
||
A case manager is assessing an unresponsive client diagnosed with terminal hepatic
|| || || || || || || || || || || ||
encephalopathy to determine equipment needs upon discharge to home for hospice care. || || || || || || || || || || || ||
Which equipment should the case manager obtain for this client? - ✔✔1. Alternating
|| || || || || || || || || || || || ||
pressure mattress ||
|| 2. Hospital bed
|| ||
|| 4. Suction equipment
|| ||
|| 5. Oxygen
||
Which client must the nurse assign to a private room? - ✔✔4. Postpartum client 32 hours
|| || || || || || || || || || || || || || || ||
after delivery with a temperature of 101º F (38.05 ° C)
|| || || || || || || || || ||
Which client requires immediate intervention by the nurse? - ✔✔3. Client with a fractured
|| || || || || || || || || || || || || ||
femur reporting sharp chest pain of 4/10.
|| || || || || ||
Which nursing tasks can the RN delegate to an unlicensed assistive personnel (UAP)? -
|| || || || || || || || || || || || || ||
✔✔2. Obtain blood pressure of client diagnosed with nephrotic syndrome.
|| || || || || || || || ||
|| 4. Document the intake and output of a client in acute renal failure.
|| || || || || || || || || || || ||
6. Perform perineal care of a client who has urinary incontinence.
|| || || || || || || || || ||
HURST REVIEW NCLEX-RN Readiness Exam 2 with accurate || || || || || || || ||
detailed solutions ||
The public health nurse is planning to participate in local forums regarding the placement
|| || || || || || || || || || || || || ||
of a factory that is known to produce pollution through discharge of chemical by-products
|| || || || || || || || || || || || || ||
into the air. What actions demonstrate ethical nursing practice in the public health arena? -
|| || || || || || || || || || || || || || ||
✔✔1. Speaking up for the underrepresented, such as the poor and uneducated persons
|| || || || || || || || || || || ||
|| 3. Requesting that forums be held throughout the community at various times of the day or
|| || || || || || || || || || || || || || ||
|| evening.
|| 4. Asking for information regarding the health status of people in other factory locations.
|| || || || || || || || || || || || ||
5. Requesting information from individuals in areas where the factories are currently
|| || || || || || || || || || || || ||
located.
Which assignment would be most appropriate for the charge nurse to assign to the LPN/VN
|| || || || || || || || || || || || || ||
in the Labor, Delivery, Recovery and Postpartum Unit (LDRP)? - ✔✔1. Primipara needing
|| || || || || || || || || || || || || ||
assistance with breastfeeding. || || ||
3. Primipara who is two days post op cesarean section.
|| || || || || || || || ||
A nurse is calling the primary healthcare provider about a client who is experiencing
|| || || || || || || || || || || || || ||
dyspnea and chest pain two days post total knee replacement. Which statements by the
|| || || || || || || || || || || || || ||
nurse are appropriate according to the communication tool SBAR (Situation, Background,
|| || || || || || || || || || ||
Assessment and Recommendation)? - ✔✔2. "Jane Doe is having increasing dyspnea and is
|| || || || || || || || || || || || ||
reporting chest pain." || ||
3. "Jane Doe had a total knee replacement two days ago. Pulse is 120, BP 128/54, Resp 32.
|| || || || || || || || || || || || || || || || || || ||
She is restless."|| ||
4. "From my assessment, I think she may be having a cardiac event or a pulmonary
|| || || || || || || || || || || || || || || || ||
embolism."
5. "I recommend that you see the client immediately and that we start oxygen stat. Do you
|| || || || || || || || || || || || || || || || || ||
agree?"
,2
Which tasks would be appropriate for the nurse to assign to an LPN/VN? - ✔✔1. Changing
|| || || || || || || || || || || || || || || ||
a colostomy bag.
|| ||
|| 2. Administer antibiotic via intravenous piggyback (IVPB).
|| || || || || ||
5. Check for urinary retention.
|| || || ||
|| 6. Remove wound sutures.
|| || ||
A 13 year old, found unresponsive in the park, is brought into the emergency department.
|| || || || || || || || || || || || || || ||
The nurse sees a medical alert bracelet stating "Diabetic", and notes a fruity smell to the
|| || || || || || || || || || || || || || || ||
breath. There are no family members available to obtain consent for treatment and an
|| || || || || || || || || || || || || ||
attempt to call them has been unsuccessful. What action should the nurse take? - ✔✔2.
|| || || || || || || || || || || || || || ||
Begin treatment by inserting two large bore IVs of Normal Saline.
|| || || || || || || || || ||
The nurse is working at the triage station. Which client should the nurse triage first? - ✔✔2.
|| || || || || || || || || || || || || || || ||
A client with a cast on the right leg who states, "My right leg is killing me and nothing I do
|| || || || || || || || || || || || || || || || || || || || || ||
makes it stop hurting. " || || || ||
A quality assurance (QA) manager plans to evaluate performance improvement regarding
|| || || || || || || || || || ||
the implementation of fall precautions for at risk clients. What steps should the QA
|| || || || || || || || || || || || || ||
manager include in this evaluation? - ✔✔1. Chart review for fall precaution documentation.
|| || || || || || || || || || || ||
|| 2. Direct observation of unit staff.
|| || || || ||
4. Identify at risk clients on unit.
|| || || || || ||
|| 5. Make unannounced visits to the unit for evaluating staff performance.
|| || || || || || || || || ||
The nurse is performing the admission assessment on a client who is having a breast
|| || || || || || || || || || || || || || ||
augmentation. Which client information would be most important for the nurse to report to || || || || || || || || || || || || ||
the surgeon before surgery? - ✔✔3. Client's last menstrual period was 8 weeks ago.
|| || || || || || || || || || || || || ||
The charge nurse has received report from the emergency department about a client
|| || || || || || || || || || || || ||
diagnosed with Cushing's disease being admitted to the unit. Which client in a semi-private
|| || || || || || || || || || || || || ||
, 2
room would be appropriate for the charge nurse to have this client share? - ✔✔3. Client
|| || || || || || || || || || || || || || || ||
who has a fractured hip.
|| || || ||
Which pediatric client should the nurse see first? - ✔✔3. Three year old with wheezes in
|| || || || || || || || || || || || || || || ||
right lower lobe. || ||
What is priority for the nurse to determine about a client who is scheduled for a tubal
|| || || || || || || || || || || || || || || || ||
ligation in the outpatient surgical center? - ✔✔3. Client's plan for transportation and care at
|| || || || || || || || || || || || || ||
home.
||
A case manager is assessing an unresponsive client diagnosed with terminal hepatic
|| || || || || || || || || || || ||
encephalopathy to determine equipment needs upon discharge to home for hospice care. || || || || || || || || || || || ||
Which equipment should the case manager obtain for this client? - ✔✔1. Alternating
|| || || || || || || || || || || || ||
pressure mattress ||
|| 2. Hospital bed
|| ||
|| 4. Suction equipment
|| ||
|| 5. Oxygen
||
Which client must the nurse assign to a private room? - ✔✔4. Postpartum client 32 hours
|| || || || || || || || || || || || || || || ||
after delivery with a temperature of 101º F (38.05 ° C)
|| || || || || || || || || ||
Which client requires immediate intervention by the nurse? - ✔✔3. Client with a fractured
|| || || || || || || || || || || || || ||
femur reporting sharp chest pain of 4/10.
|| || || || || ||
Which nursing tasks can the RN delegate to an unlicensed assistive personnel (UAP)? -
|| || || || || || || || || || || || || ||
✔✔2. Obtain blood pressure of client diagnosed with nephrotic syndrome.
|| || || || || || || || ||
|| 4. Document the intake and output of a client in acute renal failure.
|| || || || || || || || || || || ||
6. Perform perineal care of a client who has urinary incontinence.
|| || || || || || || || || ||
