National Council Licensure Examination for Registered Nurses Free Sample Questions

The most appropriate initial response is to use therapeutic communication, acknowledging the parent's perspective while providing essential health information. This approach respects the parent's beliefs, builds trust, and opens a dialogue about the importance of a definitive medical diagnosis to guide any treatment, whether conventional or complementary. Insisting on a referral or documenting refusal without education is non-therapeutic. Directly stating that chiropractic care is ineffective can alienate the parent and shut down communication.

Given the client's suicidal ideation and escalating withdrawal (refusing food/fluids), safety is the absolute priority. One-to-one observation is necessary to prevent self-harm.

The refusal of food and fluids poses a physiological risk (dehydration, electrolyte imbalance) that must be addressed urgently. This is a critical physiological need secondary only to immediate safety from self-harm.

This statement indicates correct understanding of the protocol for taking nitroglycerin for chest pain. The client should take one tablet, wait five minutes, and if pain persists, call 911 immediately. They may take up to two more doses five minutes apart while waiting for emergency services. Keeping the medication in sunlight degrades it. Driving to the hospital is unsafe. Waiting for a third tablet before calling 911 delays critical emergency response.

When there is significant family conflict regarding the goals of care for a client who cannot make their own decisions and has no advance directive, the most appropriate action is to involve an ethics committee or palliative care team. These multidisciplinary teams are trained to facilitate communication, mediate conflict, and help guide decision-making based on the client's best interests and presumed wishes. Simply following one family member's wishes or asking them to leave is inappropriate and does not resolve the ethical dilemma.

Painless, bright red vaginal bleeding in the third trimester is the classic sign of placenta previa. A sterile vaginal exam is absolutely contraindicated as it can cause catastrophic hemorrhage by perforating the placenta. An abdominal ultrasound is the immediate, non-invasive priority to confirm the location of the placenta. An amniocentesis is not indicated for bleeding, and a nonstress test assesses fetal well-being but does not diagnose the cause of bleeding.

The LPN scope of practice includes caring for stable clients with predictable outcomes. Administering routine medications like nebulizer treatments to a client with stable COPD falls within the LPN's scope. The other clients require the comprehensive assessment, planning, and teaching skills of an RN due to their instability (post-op), complex teaching needs (discharge), or need for IV push medications.

Primary prevention aims to prevent disease before it occurs. Teaching healthy lifestyle habits to children is a classic example of primary prevention for type 2 diabetes. Blood glucose screening is secondary prevention (early detection). Foot care clinics and medication management classes are tertiary prevention (managing existing disease).

Nurses are legally and ethically obligated to question any order that appears incorrect, unsafe, or unclear. A nurse who administers a medication based on an unsafe or illegible order is also liable for any harm that results. The nurse's duty is to clarify the order with the prescriber before administration.

The most therapeutic response is to acknowledge the feeling (fear) behind the delusion without reinforcing or challenging the delusion itself. This validates the client's experience while gently redirecting them to a reality-based activity and a safer-feeling environment. Directly challenging the delusion is ineffective and can increase agitation. Asking for more detail reinforces the delusional content. Asking why they believe it can also increase agitation.

Lack of tidaling (fluctuation) in the water-seal chamber can indicate either that the lung has re-expanded (a positive sign) or that there is an obstruction in the system (a negative sign). The priority action is to assess for the cause. This includes assessing the client's respiratory status (breath sounds) and checking the tubing for kinks or dependent loops. If breath sounds are diminished and the tubing is kinked, the nurse has identified a problem to correct. If breath sounds are clear and equal, it may indicate lung re-expansion, which can be confirmed with a chest x-ray. The other actions are premature or incorrect.