NCLEX PREP Archer Rated A
List in order how the PPE should be put on 1st-Gown
2nd-Mask/Respirator
3rd-Goggles
4th-Gloves
List in order how the PPE should be removed 1st-Gloves
2nd-Goggles
3rd-Gown
4th-Mask/Respirator
The nurse teaches the family of a patient with end stage renal disease to offer foods high in?
a. Fluids
b. Protein
c. Potassium
d. Carbohydrates d. Carbohydrates
A pt has an epidural for the birth of her child. While massaging the fundus, it is found to be firm and
located under the right rib cage. To alleviate this problem, the nurse should first:
a. Empty the pt's bladder
b. Initiate breast feeding the infant
c. Give Oxytocic drugs as ordered
d. Massage the uterus for another 15 minutes a. Empty the pt's bladder
The nurse is caring for a newborn who is pale and jittery and has a high-pitched cry. The Primary
nursing action is to:
a. Check the newborn's serum glucose level
b. Obtain the newborn's axillary temp
,c. Review the maternal history for substance abuse
d. Determine if the mother was anxious during the birthing process a. Check the newborn's
serum glucose level
A pt w/heart failure is receiving digoxin and furosemide. The lab values of the pt include serum
digoxin 2.9ng/mL and K+ 3.2mEq/L. Based on these lab results the most appropriate nursing action is
to:
a. Withhold the next dose of Furosemide
b. Administer an addt'l dose of digoxin
c. Notify the physician of the lab results
d. These results are w/in normal limits and require no action c. Notify the physician of the lab
results
A 64-year-old man is admitted to the ER w/complaints of shortness of breath, heartburn, and pain in
the left shoulder. After obtaining vital signs, the nurse performs a focused assessment related to the
pt's:
a. Heart
b. Abdomen
c. Current stressors
d. Recent life changes a. Heart
One nursing intervention in the plan of care for a pt w/paranoid personality disorder is promoting
consensual validation of reality. Which nursing action is most appropriate to implement this plan?
a. Reinforcing the facts of the situation
b. Encouraging verbalization of feelings
c. Administering antidepressant medications
d. Using humor to challenge patient misperceptions a. Reinforcing the facts of the situation
A 50-yr-old pt has been under extreme job stress for 10 yrs and is diagnosed as having an enlarged
heart. The nurse understands which factor in his history is a modifiable risk factor for heart disease?
, a. He eats beef once a week
b. He exercises four times a week
c. He has a family history of heart attacks
d. He smokes one pack of cigarettes a day d. He smokes one pack of cigarettes a day
Liver involvement is associated with Reye's syndrome. When caring for children with this condition,
the nurse takes with special precaution?
a. Turning and positioning
b. Assessing the level of consciousness
c. Administering intramuscular injections
d. Monitoring output from the urinary catheter c. Administering intramuscular injections
The nurse anticipates which type of isolation precautions should be taken with a 4-month old infant
with diarrhea?
a. Strict precautions
b. Droplet precautions
c. Contact precautions
d. Airborne precautions c. Contact precautions
An infant is brought to the ER by EMS with suspected SIDS. The infants' parents have accompanied
EMS and are present when the infant is pronounced dead. The most important aspect of
compassionate care for the parent is to:
a. Explain that the death is not their fault
b. Allow the parents to say goodbye to the baby
c. Gather data about the events prior to the death
d. Encourage the parents to join a support group b. Allow the parents to say goodbye to the baby
A nurse has reinforced teaching w/a client's spouse about how to change the client's colostomy bag.
The nurse Best determines that the spouse understands the procedure by:
List in order how the PPE should be put on 1st-Gown
2nd-Mask/Respirator
3rd-Goggles
4th-Gloves
List in order how the PPE should be removed 1st-Gloves
2nd-Goggles
3rd-Gown
4th-Mask/Respirator
The nurse teaches the family of a patient with end stage renal disease to offer foods high in?
a. Fluids
b. Protein
c. Potassium
d. Carbohydrates d. Carbohydrates
A pt has an epidural for the birth of her child. While massaging the fundus, it is found to be firm and
located under the right rib cage. To alleviate this problem, the nurse should first:
a. Empty the pt's bladder
b. Initiate breast feeding the infant
c. Give Oxytocic drugs as ordered
d. Massage the uterus for another 15 minutes a. Empty the pt's bladder
The nurse is caring for a newborn who is pale and jittery and has a high-pitched cry. The Primary
nursing action is to:
a. Check the newborn's serum glucose level
b. Obtain the newborn's axillary temp
,c. Review the maternal history for substance abuse
d. Determine if the mother was anxious during the birthing process a. Check the newborn's
serum glucose level
A pt w/heart failure is receiving digoxin and furosemide. The lab values of the pt include serum
digoxin 2.9ng/mL and K+ 3.2mEq/L. Based on these lab results the most appropriate nursing action is
to:
a. Withhold the next dose of Furosemide
b. Administer an addt'l dose of digoxin
c. Notify the physician of the lab results
d. These results are w/in normal limits and require no action c. Notify the physician of the lab
results
A 64-year-old man is admitted to the ER w/complaints of shortness of breath, heartburn, and pain in
the left shoulder. After obtaining vital signs, the nurse performs a focused assessment related to the
pt's:
a. Heart
b. Abdomen
c. Current stressors
d. Recent life changes a. Heart
One nursing intervention in the plan of care for a pt w/paranoid personality disorder is promoting
consensual validation of reality. Which nursing action is most appropriate to implement this plan?
a. Reinforcing the facts of the situation
b. Encouraging verbalization of feelings
c. Administering antidepressant medications
d. Using humor to challenge patient misperceptions a. Reinforcing the facts of the situation
A 50-yr-old pt has been under extreme job stress for 10 yrs and is diagnosed as having an enlarged
heart. The nurse understands which factor in his history is a modifiable risk factor for heart disease?
, a. He eats beef once a week
b. He exercises four times a week
c. He has a family history of heart attacks
d. He smokes one pack of cigarettes a day d. He smokes one pack of cigarettes a day
Liver involvement is associated with Reye's syndrome. When caring for children with this condition,
the nurse takes with special precaution?
a. Turning and positioning
b. Assessing the level of consciousness
c. Administering intramuscular injections
d. Monitoring output from the urinary catheter c. Administering intramuscular injections
The nurse anticipates which type of isolation precautions should be taken with a 4-month old infant
with diarrhea?
a. Strict precautions
b. Droplet precautions
c. Contact precautions
d. Airborne precautions c. Contact precautions
An infant is brought to the ER by EMS with suspected SIDS. The infants' parents have accompanied
EMS and are present when the infant is pronounced dead. The most important aspect of
compassionate care for the parent is to:
a. Explain that the death is not their fault
b. Allow the parents to say goodbye to the baby
c. Gather data about the events prior to the death
d. Encourage the parents to join a support group b. Allow the parents to say goodbye to the baby
A nurse has reinforced teaching w/a client's spouse about how to change the client's colostomy bag.
The nurse Best determines that the spouse understands the procedure by:
