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National Council Licensure Examination(NCLEX-PN) Questions 421–425 (page: 86)

Updated On: 9-Feb-2026

A community health nurse is asked to organize a health promotion project that plans to provide glucose screening.

This activity is most beneficial within what realm?

  1. testing that is performed by volunteers at a local department store and is open to the public
  2. at a professional health fair activity available for selected persons who have been screened as being at risk
  3. mass-marketing vouchers for free fingersticks at a local drug store, where the pharmacist makes recommendations on the findings
  4. testing that is performed by a nurse professional, who immediately provides education regarding the findings

Answer(s): B

Explanation:

Public glucose screening has been found to be an ineffective way to screen for diabetes unless based on health risk screening for those persons identified to be at risk or displaying symptoms.



Hearing screening of prematurely born infants is an effective means of identifying disease and is an example of ______________.

  1. primary prevention
  2. secondary prevention
  3. tertiary prevention
  4. disability prevention

Answer(s): B

Explanation:

The three levels of prevention address disease and disability across all phases, from absence of disease and at risk for disease, to preventing further impairment.
Hearing impairment associated with prematurity cannot be prevented by screening, but identifying the infants with hearing loss might prevent sequelae and further impairment by allowing early intervention.



The nurse is preparing to administer IV Vancomycin to a client. Which of the following nursing actions should be taken first?

  1. performing a physical assessment prior to administration
  2. obtaining the most recent lab values regarding renal function
  3. reviewing peaks and troughs for the past few days
  4. ensuring the client is not allergic to the medication

Answer(s): D

Explanation:

Even before the physical assessment (which might or might not be indicated at the time of administration of Vancomycin), ensuring that the client is not allergic to the medication is the most critical action the nurse must take before administering any drug.
Lab values regarding renal functioning and therapeutic ranges via peaks and troughs are also important with some medications such as Vancomycin because renal damage can occur if blood drug levels remain high over time.



The orientation nurse educator reviewing the biohazard legend with a class of new employees states that the emblem is affixed to containers whenever ______________.

  1. there is presence of blood and body fluids
  2. there is the need for droplet precaution
  3. there is contact isolation
  4. there is the potential for airborne transmission

Answer(s): A

Explanation:

When body substances are handled, the potential for transmission is increased; therefore, federal regulations require warning labels to communicate with other employees and/or waste collectors.
The biohazard alert is a three-ring symbol overlaying a central concentric ring.
Blood, drainagefrom wounds, feces, and urine are all body fluids that can transfer infection and disease to others.



The emergency triage nurse should perform which action upon receiving the history that a client has a severe cough, fever, night sweats, and body wasting?

  1. Place the client in the waiting room until an available cubicle is open.
  2. Seclude the client from other clients and visitors.
  3. Perform no intervention because it might not be necessary until tests confirm a disease.
  4. Don gown, gloves, and mask immediately.

Answer(s): B

Explanation:

The client is describing signs and symptoms of tuberculosis.
The client is potentially infectious to others and should be secluded. A respirator mask should be worn by caregivers, but it is not necessary for the nurse to don a gown and gloves.
If the client is moved to other areas such as radiology, a mask should be worn by the client and a respirator mask should be worn by those working in close contact with the client.



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