NCLEX Daily Practical Exercise 36

Welcome to our NCLEX Daily Ten Practice! This practice is designed to help you solidify your knowledge, improve your skills, and prepare thoroughly for the NCLEX exam. With ten questions to tackle each day, you’ll have the opportunity to review a broad range of subjects covered in the NCLEX exam.

 

1. While explaining an illness to a 10-year-old, what should the nurse keep in mind about the cognitive development at this age?

Correct Answer: B

Answer Explanation:

The child in the concrete operational stage, according to Piaget, is capable of mature thought when allowed to manipulate and organize objects.

Option A: Option A describes the preoperational stage. During this stage, young children can think about things symbolically. The preoperational stage is the second stage in Piaget’s theory of cognitive development. This stage begins around age 2, as children start to talk, and lasts until approximately age 7. 1 During this stage, children begin to engage in symbolic play and learn to manipulate symbols.
Option C: In the formal operational stage, people develop the ability to think about abstract concepts, and logically test hypotheses.
Option D: Option D describes the formal operational stage. The formal operational stage begins at approximately age twelve and lasts into adulthood. As adolescents enter this stage, they gain the ability to think in an abstract manner by manipulating ideas in their head, without any dependence on concrete manipulation.

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2. The nurse has just admitted a client with severe depression. From which focus should the nurse identify a priority nursing diagnosis?

Correct Answer: D

Answer Explanation:

Safety is a priority of care for the depressed client. Precautions to prevent suicide must be a part of the plan. Depression can be effectively treated in primary care settings using an evidence-based collaborative approach in which primary care providers are systematically supported by mental health providers in caring for a caseload of patients.

Option A: The client’s nutritional plan can be discussed after his safety has been ensured. Researchers found that a healthy diet (the Mediterranean diet as an example) was associated with a significantly lower risk of developing depressive symptoms.
Option B: Elimination should also be part of the nursing care plan, but this is not the priority. Any psychosocial disturbances can impact on nervous system neuroplasticity and this, in turn, will adversely affect downstream systems including the GIT.
Option C: Activities for a depressed client should be structured and introduced gradually. Teach visualization as a tool to “bring them back down to their bodies” and out of the constant cycle of negative thoughts. Clients learn methods such as the “tree meditation,” in which they imagine themselves as a tree that is growing from the ground and sprouting branches.

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3. Which playroom activities should the nurse organize for a small group of 7-year-old hospitalized children?

Correct Answer: A

Answer Explanation:

The purpose of play for the 7-year-old is cooperation. Rules are very important. Logical reasoning and social skills are developed through play.

Option B: Finger paints and water play are appropriate play for toddlers. Most toddlers do parallel play. When a child plays alongside or near others but does not play with them this stage is referred to as parallel play.
Option C: Dress-up and props are recommended for preschool. When a child plays together with others and has interest in both the activity and other children involved in playing they are participating in cooperative play.
Option D: Chess is recommended for school-age to adolescent stage. During the school-age years, you’ll see a change in your child. He or she will move from playing alone to having multiple friends and social groups.

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4. A client is discharged following hospitalization for congestive heart failure. The nurse teaching the family suggests they encourage the client to rest frequently in which of the following positions?

Correct Answer: A

Answer Explanation:

Sitting in a chair or resting in a bed in a high Fowler”s position decreases the cardiac workload and facilitates breathing.

Option B: Lying flat or in a supine position would be difficult for the client and may induce increased cardiac workload.
Option C: Left lateral position may increase the client’s cardiac workload.
Option D: Low Fowler’s may not be sufficient enough to support the client’s cardiac workload.

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5. The nurse is caring for a 10-year-old on admission to the burn unit. One assessment parameter that will indicate that the child has adequate fluid replacement is:

Correct Answer: A

Answer Explanation:

For a child of this age, this is adequate output, yet does not suggest overload. Disruption of sodium-ATPase activity presumably causes an intracellular sodium shift which contributes to hypovolemia and cellular edema. Heat injury also initiates the release of inflammatory and vasoactive mediators. These mediators are responsible for local vasoconstriction, systemic vasodilation, and increased transcapillary permeability. Increase in transcapillary permeability results in a rapid transfer of water, inorganic solutes, and plasma proteins between the intravascular and interstitial spaces.

Option B: Relying on the client’s thirst would not create accurate results. The steady intravascular fluid loss due to these sequences of events requires sustained replacement of intravascular volume in order to prevent end-organ hypoperfusion and ischemia.
Option C: An increase in hematocrit suggests vascular space fluid losses. Reduced cardiac output is a hallmark in this early post-injury phase. The reduction in cardiac output is the combined result of decreased plasma volume, increased afterload and decreased cardiac contractility, induced by circulating mediators.
Option D: A good skin turgor is not an accurate indicator of adequate fluid replacement. The goal of fluid management in major burn injuries is to maintain the tissue perfusion in the early phase of burn shock, in which hypovolemia finally occurs due to steady fluid extravasation from the intravascular compartment.

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