NCLEX Daily Practical Exercise 41

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. A male client has jugular distention. In what position should the nurse place the head of the bed to obtain the most accurate reading of jugular vein distention?\

Correct Answer: C

Answer Explanation:

Jugular venous pressure is measured with a centimeter ruler to obtain the vertical distance between the sternal angle and the point of highest pulsation with the head of the bed inclined between 15 to 30 degrees.

Option A: In high Fowler’s position, the veins would be barely discernible above the clavicle.
Option B: Increased pressure can’t be seen when the head of the bed is raised 10 degrees because the point that marks the pressure level is above the jaw (therefore, not visible).
Option D: Supine position does not make the increased pressure level seen.

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2. The nurse is aware that one of the following classes of medications maximizes cardiac performance in clients with heart failure by increasing ventricular contractility?

Correct Answer: D

Answer Explanation:

Inotropic agents are administered to increase the force of the heart’s contractions, thereby increasing ventricular contractility and ultimately increasing cardiac output.

Option A: Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation.
Option B: Calcium channel blockers decrease the heart rate and ultimately decrease the workload of the heart.
Option C: Diuretics are administered to decrease the overall vascular volume, also decreasing the workload of the heart.

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3. A male client has a reduced serum high-density lipoprotein (HDL) level and an elevated low-density lipoprotein (LDL) level. Which of the following dietary modifications is not appropriate for this client?

Correct Answer: B

Answer Explanation:

A client with low serum HDL and high serum LDL levels should get less than 30% of daily calories from fat.

Option A: Fiber intake should be adequate to aid in proper digestion.
Option C: High cholesterol intake can cause fatty deposits in the blood vessels. Eventually, these deposits grow, making it difficult for enough blood to flow through the arteries.
Option D: Saturated fat increases cholesterol and the risk for heart disease and stroke, therefore it should be reduced too.

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4. A 37-year-old male client was admitted to the coronary care unit (CCU) 2 days ago with acute myocardial infarction. Which of the following actions would breach the client’s confidentiality?

Correct Answer: C

Answer Explanation:

The emergency department nurse is no longer directly involved with the client’s care and thus has no legal right to information about his present condition.

Option A: Anyone directly involved in his care (such as the telemetry nurse) has the right to information about his condition.
Option B: The on-call physician should be updated about the client’s condition.
Option D: Because the client requested that the nurse update his wife on his condition, doing so doesn’t breach confidentiality.

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5. A male client arriving in the emergency department is receiving cardiopulmonary resuscitation from paramedics who are giving ventilation through an endotracheal (ET) tube that they placed in the client’s home. During a pause in compressions, the cardiac monitor shows narrow QRS complexes and a heart rate of beats/minute with a palpable pulse. Which of the following actions should the nurse take first?

Correct Answer: B

Answer Explanation:

ET tube placement should be confirmed as soon as the client arrives in the emergency department. Once the airway is secured, oxygenation and ventilation should be confirmed using an end-tidal carbon dioxide monitor and pulse oximetry.

Option A: Next, the nurse should make sure L.V. access is established.
Option D: If the client experiences symptomatic bradycardia, atropine is administered as ordered 0.5 to 1 mg every 3 to 5 minutes to a total of 3 mg.
Option C: Then the nurse should try to find the cause of the client’s arrest by obtaining an ABG sample. Amiodarone is indicated for ventricular tachycardia, ventricular fibrillation, and atrial flutter – not symptomatic bradycardia.

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