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NCLEX PN Questions with Answer 2020/ 2021 129th Edition
1. A client with tuberculosis (TB) who is being prepared for discharge to home should be instructed to do which of the following to decrease the possibility of spreading the infection?
A. Wear a mask when in contact with people outside the family until medications are effective
B. Wear a mask when at home with family members
C. Obtain a weekly sputum culture to follow the course of the infection
D. Obtain a bacille Calmette-Guérin (BCG) vaccination to protect other people from exposure
Answer: A. Wear a mask when in contact with people outside the family until medications are effective
Rationale: TB is an airborne illness. In the home situation, family members are best protected by careful hand washing. Since they are already exposed, masks would not be of much benefit. However, masks to protect people outside the family can be beneficial and should be recommended. Sputum cultures may be ordered to evaluate the effectiveness of therapy, but not on a weekly basis. BCG is a vaccine that produces increased resistance to TB. BCG is recommended in areas where there is a high rate of TB, but it renders future skin tests invalid in those who receive it. Test-Taking Strategy: Use the process of elimination and note the key words decrease the possibility of spreading the infection. Focusing on this issue will assist in eliminating options 3 and D. From the remaining options, eliminate option 2 recalling that in the home situation family members have already been exposed by the time the diagnosis is confirmed, but those outside the family can be protected with a mask. Review home care measures for the client with TB if you had difficulty with this question.
Level of Cognitive Ability: Application
Client Needs: Safe, Effective Care Environment
Integrated Process: Teaching/Learning
Content Area: Fundamental Skills
References: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders,
p. 1849.
Christensen, B., & Kockrow, E. (2003). Adult health nursing (4th ed.). St. Louis: Mosby,
pp. 375-379.
2. In developing a plan of care for a client hospitalized with tuberculosis (TB), which of the following is the most important fact for the nurse to consider?
A. TB is primarily a respiratory infection that requires airborne precautions
B. The client will need special assistance to perform activities of daily living (ADL)
C. The client will need to increase fluid intake to at least 3000 mL a day
D. The client will need to be taught proper breathing techniques
Answer: A. TB is primarily a respiratory infection that requires airborne precautions
Rationale: TB is a respiratory infection that requires the use of airborne precautions to prevent transmission of infection. Planning care in such a way as to decrease the transmission of infection to others provides for safety. Plans to increase fluid intake or assist with ADL are pertinent to many clients, but are not of highest priority. Proper breathing techniques have no relevance in care of the client with TB.
Test-Taking Strategy: Use the process of elimination and knowledge regarding the methods of transmission of TB to answer this question. Recalling that TB is transmitted via the airborne route will direct you to option A. Review the method of transmission of TB if you had difficulty with this question.
Level of Cognitive Ability: Analysis
Client Needs: Safe, Effective Care Environment
Integrated Process: Nursing Process/Planning
Content Area: Fundamental Skills
Reference: Linton, A., & Maebius, N. (2003). Introduction to medical-surgical nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 506.
3. A gastric analysis is prescribed for a client with a suspected diagnosis of tuberculosis (TB). The nurse understands that this test may be prescribed as a part of the work-up to determine the diagnosis because:
A. Anorexia and weight loss are frequently symptoms of tuberculosis
B. Extrapulmonary TB may be found in the gastrointestinal tract
C. The bacillus is often swallowed with contaminated food
D. People frequently swallow small amounts of sputum rather than expectorating them
Answer: D. People frequently swallow small amounts of sputum rather than expectorating them
Rationale: Gastric analysis is a test that aspirates stomach contents and examines them for many factors, the primary one being pH. Since many people cough and swallow rather than spit out their sputum, viewing stomach contents can be diagnostic. Anorexia and weight loss cannot be detected with gastric analysis and neither can extrapulmonary TB. Options 1, 2, and 3 are incorrect.
Test-Taking Strategy: Focus on the issue, a gastric analysis. Noting that this test is being performed as a diagnostic measure will direct you to option D. Remember that the tubercle bacillus is found in the sputum. Review diagnostic procedures for TB if you had difficulty with this question.
Level of Cognitive Ability: Comprehension
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Planning
Content Area: Adult Health/Respiratory
References: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p. 1846.
Chernecky, C., & Berger, B. (2004). Laboratory tests and diagnostic procedures (4th ed.). Philadelphia: W.B. Saunders, pp. 586-587.
4. A nurse is assigned to care for a client who has human immunodeficiency virus (HIV). In planning to care for the client, the nurse understands that the most important principle to decrease the risk of infection for the nurse is:
A. How and when to use the personal protective equipment supplied
B. Knowing the HIV status of every client on the unit
C. How far away from the client to stand when giving care
D. Determining whether the client has been placed in protective isolation
Answer: A. How and when to use the personal protective equipment supplied
Rationale: HIV is a blood-borne illness with a long latency period between the introduction of the virus and positive results on a blood test. This makes it unrealistic and unreliable to test every client on a hospital unit. Testing every client is also questionable from an ethical perspective. Protective isolation is meant to protect the client with decreased immune function, not to protect the nurse. Standing far away from the client isolates the client emotionally and does not protect the nurse unless there is risk of splatter from blood. The Centers for Disease Control and Prevention guidelines are specific regarding when and how to use protective equipment and are a nurse’s best protection.
Test-Taking Strategy: Use the process of elimination and focus on the issue, decreasing the risk of infection. Recalling the principles related to standard precautions will direct you to option A. Review these principles if you had difficulty with this question.
Level of Cognitive Ability: Application
Client Needs: Safe, Effective Care Environment
Integrated Process: Nursing Process/Planning
Content Area: Fundamental Skills
Reference: deWit, S. (2005). Fundamental concepts and skills for nursing. Philadelphia: W.B. Saunders, pp. 224-225.
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