NCLEX NCLEX-PN試験問題集で[2023年最新] 有効な試験練習問題集解答
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質問 # 353
The intent of the Patient Self Determination Act (PSDA) of 1990 is to __________.
- A. encourage medical treatment decision making prior to need
- B. emphasize client education
- C. give one federal standard for living wills and durable powers of attorney
- D. enhance personal control over legal care decisions
正解：A
解説：
Section: Safe and Effective Care Environment
Explanation:
The purpose of the PSDA is to promote decision-making prior to need.
Choices "enhance personal control over legal care decisions", "give one federal standard for living wills and durable powers of attorney" and "emphasize client education" are incorrect.
The focus of the PSDA is individual health care decision-making. A federal standard for advance directives does not exist. Each state has jurisdiction regarding these policies and protocols.
質問 # 354
A spinal change occurring with pregnancy that alters mobility is __________.
- A. ankylosing spondylitis
- B. scoliosis
- C. kyphosis
- D. lordosis
正解：D
解説：
Section: Physiological Integrity
Explanation:
The spinal change occurring with pregnancy is lordosis.
This occurs due to the weight of the enlarging uterus and the effect of gravity.
質問 # 355
A 4-year-old client is unable to go to sleep at night in the hospital. Which nursing intervention best promotes sleep for the child?
- A. tiring the child during the evening with play exercises
- B. encouraging visitation by friends during the evening
- C. turning out the room light and closing the door
- D. identifying the child's home bedtime rituals and following them
正解：D
解説：
Preschool-age children require bedtime rituals that should be followed in the hospital if possible. Choice 1 increases a child's fear. Choices 2 and 4 do not promote sleep. Basic Care and Comfort
質問 # 356
A nursing advocate is one who __________.
- A. manages the care of others
- B. encourages persons to make decisions for themselves and acts with or on behalf of the person to support those decisions
- C. makes decisions for others
- D. is the legal representative for a person
正解：B
解説：
Section: Safe and Effective Care Environment
Explanation:
Nurse advocates work with clients to provide information and assistance is decision-making.
The decisions and care that occur from these decisions are based on the right of the client to self- determination and the work of the nurse advocate supports this right.
質問 # 357
Which of the following statements is correct regarding rape?
- A. Most rapes are reported.
- B. The most common location of rape is the victim's own home.
- C. Legally, a woman can be raped by her spouse.
- D. Prosecution and conviction for rape is easy.
正解：C
解説：
Section: Psychosocial Integrity
Explanation:
The definition of rape is sexual intercourse against someone's will.
It is a degrading, brutal crime of violence and can occur between any two persons regardless of their marital status.
質問 # 358
A client, age 28, is 8 1⁄2 months pregnant. She is most likely to display which normal skin-color variation?
- A. cyanosis
- B. vitiligo
- C. erythema
- D. chloasma
正解：D
解説：
Explanation/Reference:
Explanation:
Chloasma, also known as the mask of pregnancy, is described as tan-to-brown patches on the face. This hyperpigmentation results from hormonal changes. Health Promotion and Maintenance
質問 # 359
American families are having difficulty adequately performing their vital health care function. What are the basic reasons for this difficulty?
- A. psychological factors for men and women seeking health care
- B. structure of the health care system and family structure
- C. conditions being labeleddisabilitiesand seen as too time consuming
- D. health care organizations (HMOs) and disconnected families
正解：B
解説：
Scholars suggest that the reasons families are having difficulty providing health care for their members lies with both the structure of the health care system and the family structure. Major factors explaining differences in utilization patterns of medical services include the lack of healthcare insurance coverage, lack of services for special populations (that is, teenage males), perception by families of the health care system and the health care provider, and lack of partnership between health care providers and families in mutually addressing health care issues.Health Promotion and Maintenance
質問 # 360
When giving an intramuscular injection to an infant. Which of the following sites is preferred?
- A. Deltoid
- B. Dorsogluteal region
- C. Vastus lateralis
- D. Ventrogluteal region
正解：C
解説：
Explanation/Reference:
Explanation:
Vastus lateralis is the ideal choice for infants.
質問 # 361
An LPN is discussing medication safety with a toddler patient's parent.
Which statement made by the parent would be a cause for concern?
- A. "I always check to make sure the safety cap 'clicks' when I close it."
- B. "We store all of our medicine on a really high shelf that even I need a step stool to reach."
- C. "We store our medicines and vitamins together."
- D. "To get her to take her medicine, we just tell her it's like candy."
正解：D
解説：
Section: Safe and Effective Care Environment
質問 # 362
A pregnant client has congenital heart disease. The nurse should expect to see which alterations in this client's diet during pregnancy?
- A. fluid restriction and reduced calories
- B. caffeine and sodium restrictions
- C. reduced calories and reduced fat
- D. decreased protein and increased complex carbohydrates
正解：B
解説：
Explanation/Reference:
Explanation:
Caffeine might increase heart rate that is already stressed due to pregnancy. Sodium can cause fluid retention. Both might need to be restricted. The other choices are incorrect because calories, fat, and protein are not usually decreased due to the risk of nutrient deficiencies. Basic Care and Comfort
質問 # 363
A client with Kawasaki disease has bilateral congestion of the conjunctivae, dry cracked lips, a strawberry tongue, and edema of the hands and feet followed by desquamation of fingers and toes. Which of the following nursing measures is most appropriate to meet the expected outcome of positive body image?
- A. assessing the extremities for edema, redness and desquamation every 8 hours
- B. explaining progression of the disease to the client and his or her family
- C. assessing heart sounds and rhythm
- D. administering immune globulin intravenously
正解：B
解説：
Explanation/Reference:
Explanation:
Teaching the client and family about progression of the disease includes explaining when symptoms can be expected to improve and resolve. Knowledge of the course of the disease can help them understand that no permanent disruption in physical appearance will occur that could negatively affect body image.
Clients with Kawasaki disease might receive immune globulin intravenously to reduce the incidence of coronary artery lesions and aneurysms. Cardiac effects could be linked to body image, but Choice 3 is the most direct link to body image.
The nurse assesses symptoms to assist in evaluation of treatment and progression of the disease. Health Promotion and Maintenance
質問 # 364
Activities of effective supervisors can be taskrelated or people-related activities. An example of a task-related supervisory activity is:
- A. coaching.
- B. evaluating.
- C. delegating.
- D. facilitating.
正解：C
解説：
Delegating is the act (or task) of assigning work to those that are capable and competent to do the work. Coaching, evaluating, and facilitating are supervisory activities that are people related.Coordinated Care
質問 # 365
A patient has fallen off a bicycle and fractured the head of the proximal fibula. A cast was placed on the patient's lower extremity. Which of the following is the most probable result of the fall?
- A. Femoral nerve injury
- B. Sciatic nerve injury
- C. Tibial nerve injury
- D. Peroneal nerve injury
正解：D
解説：
Explanation/Reference:
Explanation:
The head of the proximal fibula is in close proximity to the peroneal nerve.
質問 # 366
The PN is caring for a client with diabetes insipidus.
The nurse can expect the lab work to show __________.
- A. elevated urine osmolarity and elevated serum osmolarity
- B. decreased urine osmolarity and decreased serum osmolarity
- C. decreased urine osmolarity and elevated serum osmolarity
- D. elevated urine osmolarity and decreased serum osmolarity
正解：C
解説：
Section: Physiological Integrity
Explanation:
In diabetes insipidus, the pituitary releases too much antidiuretic hormone (ADH) causing the client to produce a large amount of dilute (decreased osmolarity) urine and causing dehydration (elevated serum osmolarity).
Elevated urine osmolarity and decreased serum osmolarity might be seen in a client with SIADH (syndrome of inappropriate ADH).
Elevated urine osmolarity and elevated serum osmolarity, decreased urine osmolarity and decreased serum osmolarity generally don't occur - urine and serum osmolarity typically move in opposite directions.
質問 # 367
The nurse teaching a client about hepatitis and its transmission should explain that one type of hepatitis does not produce a carrier state after its acute phase. Which type is it?
- A. hepatitis A
- B. hepatitis B
- C. hepatitis C
- D. hepatitis D
正解：A
解説：
Explanation/Reference:
Explanation:
Hepatitis A does not produce a carrier state. It is transmitted via contaminated water or food via the oral- fecal route and is not blood borne. Safety and Infection Control
質問 # 368
Which of the following is a predisposing factor for cancer of the tongue?
- A. tobacco use
- B. sun exposure
- C. eating sweets
- D. obesity
正解：A
解説：
Section: Physiological Integrity
Explanation:
Tobacco use is a predisposing factor for cancer of the tongue; the other choices are not.
質問 # 369
What is the appropriate ratio of cardiac compressions to ventilations in an adult client for one-person CPR?
- A. 2:15
- B. 5:1
- C. 15:2
- D. 1:5
正解：C
解説：
Explanation/Reference:
Explanation:
The appropriate ratio for adult CPR is 15 compressions to 2 ventilations. Reduction of Risk Potential
質問 # 370
American families are having difficulty adequately performing their vital health care function. What are the basic reasons for this difficulty?
- A. psychological factors for men and women seeking health care
- B. conditions being labeled disabilities and seen as too time consuming
- C. structure of the health care system and family structure
- D. health care organizations (HMOs) and disconnected families
正解：C
解説：
Explanation/Reference:
Explanation:
Scholars suggest that the reasons families are having difficulty providing health care for their members lies with both the structure of the health care system and the family structure. Major factors explaining differences in utilization patterns of medical services include the lack of healthcare insurance coverage, lack of services for special populations (that is, teenage males), perception by families of the health care system and the health care provider, and lack of partnership between health care providers and families in mutually addressing health care issues. Health Promotion and Maintenance
質問 # 371
The hormone produces mother's milk is __________.
- A. Progesterone
- B. Colostrum
- C. Estrogen
- D. Prolactin
正解：D
解説：
Section: Health Promotion and Maintenance
Explanation:
Prolactin is a protein that is best known for its role in enabling females to produce milk, but it also has other functions, such as regulating the immune system.
Progesterone has many roles relating to the development of the fetus during pregnancy.
Estrogens are best known for their importance in both menstrual and estrous reproductive cycles.
Colostrum is the most nutrient dense part of breast milk produced during the postpartum stage.
質問 # 372
Which is the best way to position a client's neck for palpation of the thyroid?
- A. flexed away from the side being examined
- B. flexed toward the side being examined
- C. flexed directly forward
- D. hyperextended directly backward
正解：B
解説：
Explanation/Reference:
Explanation:
Flexed toward the side being examined. Health Promotion and Maintenance
質問 # 373
The PN has been asked to help a patient taking Risperdal with activities of daily living in the morning.
Which of these tasks is most likely to be potentially impacted by this medication?
- A. brushing teeth
- B. drinking fluids
- C. eating breakfast
- D. getting out of bed to use the bathroom
正解：D
解説：
Section: Physiological Integrity
質問 # 374
A client is assessed by the nurse as experiencing a crisis. The nurse plans to:
- A. complete an in-depth evaluation of stressors and responses to the situation.
- B. recommend ongoing therapy.
- C. allow the client to work through independent problem-solving.
- D. focus on immediate stress reduction.
正解：D
解説：
A crisis is an acute, time-limited state of disequilibrium resulting from a situational, developmental, or societal source of stress. Utilizing the nursing process, the nurse should assist clients to work through a crisis to its resolution and restore their precrisis level of functioning.Psychosocial Integrity
質問 # 375
Place these human needs in order from the greatest priority to the least priority using 1 as the greatest priority and 5 as the least of all in terms of priority.
- A. E, C, D, B, A
- B. E, C, D, A, B
- C. E, C, A, D, B
- D. C, E, D, A, B
正解：B
解説：
Section: Health Promotion and Maintenance
Explanation:
According to Abraham Maslow, the hierarchy of human needs from the most basic and necessary to the least priority are the physiological or biological needs, the safety and psychological needs, the need for love and belonging, self-esteem and the esteem by others and self-actualization.
Maslow's theory states that until the most basic priority needs are satisfied in a step wise manner, the less priority needs cannot be addressed and fulfilled.
質問 # 376
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NCLEX-PN（実践的看護師のための全国評議会免許試験）は、アメリカ合衆国の実践的看護師（PNS）の能力と知識を評価するために設計された標準化された試験です。この試験は、看護免許試験を開発および管理することにより公衆衛生と安全を促進することを目的とした非営利組織である国家評議会看護師（NCSBN）によって管理されています。 NCLEX-PN試験は、PNが看護ライセンスを取得し、看護職でのキャリアを開始するための意欲的なステップです。
NCLEX-PN 試験は、85〜205 の多肢選択問題から構成され、最大５時間かかる可能性があります。この試験はコンピュータ適応型であり、質問の難易度は候補者の能力レベルに応じて適応します。この試験は、安全で効果的なケア環境、健康促進と維持、心理社会的完全性、生理的完全性の４つの主要なカテゴリをカバーしています。質問は、薬理学、患者ケア、看護倫理、看護プロセスなどのトピックをカバーする場合があります。
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