NCLEX Daily Ten Question Practical Exercise 12

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 45-year-old male, working as a construction engineer, is brought to the emergency department after an accident where he fell from a 2-story building. Upon arrival, he is found to be unconscious with no external signs of injury except for minor abrasions. The patient’s medical history is significant for hypertension, controlled with medication. There is no information available about the circumstances of the fall or the exact nature of the impact. The nurse’s assessment focuses on identifying immediate life-threatening injuries, particularly those related to potential head trauma, spinal injury, or internal bleeding. Given this scenario, which of the following assessment findings should the nurse be most concerned about?

Correct Answer: C

Answer Explanation:

The nurse needs to perform a thorough assessment that could indicate alterations in cerebral function, increased intracranial pressures, fractures, and bleeding. Bleeding from the ears occurs only with basal skull fractures that can easily contribute to increased intracranial pressure and brain herniation.

Option A: The normal pupil size varies from 2 to 4 mm in diameter in bright light to 4 to 8 mm in the dark. The pupils are generally equal in size. They constrict to direct illumination and to illumination of the opposite eye. The pupil dilates in the dark. Both pupils constrict when the eye is focused on a near object.
Option B: The anterior fontanelle remains soft until about 18 months to 2 years of age. The posterior fontanelle usually closes first, during the first several months of an infant’s life.
Option D: Hypothermic trauma patients are less likely to survive their injuries when compared to similar patients who are normothermic. Hypothermia in conjunction with metabolic acidosis and impair coagulation creates a “lethal triad”, which significantly worsens the chances of recovery from a critical injury.

2. A 67-year-old male patient who recently had a permanent artificial pacemaker implanted is receiving education from the nurse about managing his health and lifestyle with the device. The patient enjoys an active lifestyle and is keen to understand what activities and precautions are necessary with his new pacemaker. He also uses various electrical appliances at home and is concerned about how they might affect his pacemaker. In this scenario, which piece of information provided by the nurse indicates a knowledge deficit regarding the management of a patient with an artificial cardiac pacemaker?

Correct Answer: D

Answer Explanation:

The client should be advised by the nurse to avoid contact sports. This will prevent trauma to the area of the pacemaker generator.

Option A: The physician may advise to take and record the pulse rate often to gauge the heart rate. This allows comparison of the heart rate to the acceptable range to determine if the pacemaker is working effectively.
Option B: Use of electrical appliances is allowed, but the client must maintain a distance from the appliances. Devices such as anti-theft systems, metal detectors, cell phones, mp3 players/headphones, radios, power-generating equipment, magnets, etc may interfere with a pacemaker.
Option C: Modern pacemakers are built to last. Still, it needs to be checked periodically to assess the battery and find out how the wires are working, so it is a must to keep pacemaker checkup appointments.

3. A 68-year-old male patient with a history of Chronic Obstructive Pulmonary Disease (COPD) is admitted to the hospital with exacerbation of his respiratory symptoms. He is experiencing shortness of breath and his blood oxygen levels are low. The nurse is planning the oxygen therapy for this patient, considering the specific needs of patients with COPD. Which statement reflects the most relevant knowledge about oxygen administration to a patient with COPD?

Correct Answer: A

Answer Explanation:

COPD causes a chronic CO2 retention that renders the medulla insensitive to the CO2 stimulation for breathing. The hypoxic state of the client then becomes the stimulus for breathing. Giving the client oxygen in low concentrations will maintain the client’s hypoxic drive.

Option B: The hypoxic state of the client is the stimulus for breathing.
Option C: The client may use the Venturi mask as a high flow device that delivers a fixed oxygen concentration and is best for clients with COPD.
Option D: Blood gas analysis or arterial blood gas (ABG) test measures the amount of oxygen and carbon dioxide in the blood. It may also be used to determine the pH of the blood, or how acidic it is.

4.

A 58-year-old male patient has recently undergone a left thoracotomy and a partial pneumonectomy to treat lung cancer. Post-surgery, chest tubes are inserted, and one-bottle water-seal drainage is instituted. In the postanesthesia care unit, the nurse positions the client in Fowler’s position on his right side or on his back. The nurse understands that this positioning is critical for postoperative recovery.

Understanding the implications of postoperative positioning, the nurse is aware that placing the patient in Fowler’s position on either his right side or on his back primarily:

Correct Answer: B

Answer Explanation:

Since only a partial pneumonectomy is done, there is a need to promote expansion of this remaining left lung by positioning the client on the opposite unoperated side.

Option A: This position may reduce the pressure on the surgical incision site, but it is not its priority.
Option C: Fowler’s position is associated with improvement of functional residual capacity, oxygenation, and reduction of work of breathing.
Option D: On the transition from sitting to standing, blood is pooled in the lower extremities as a result of gravitational forces. Venous return is reduced, which leads to a decrease in cardiac stroke volume, a decline in arterial blood pressure, and an immediate decrease in blood flow to the brain.

5. A 42-year-old female patient is scheduled for a bronchoscopy to investigate recent breathing difficulties and a persistent cough. Post-procedure care is crucial for her safety and recovery. The nurse is providing the patient with pre-procedure education, emphasizing the most important aspects of post-procedure care. In teaching the patient what to expect and how to care for herself after the bronchoscopy, what is the highest priority information the nurse should provide?

Correct Answer: A

Answer Explanation:

Prior to bronchoscopy, the doctors spray the back of the throat with anesthetic to minimize the gag reflex and thus facilitate the insertion of the bronchoscope. Giving the client food and drink after the procedure without checking on the return of the gag reflex can cause the client to aspirate. The gag reflex usually returns after two hours.

Option B: Warm saline gargles may help soothe the throat after bronchoscopy.
Option C: Coughing should not be done after bronchoscopy to avoid initiating bleeding.
Option D: The client should be on NPO status after bronchoscopy until gag reflex has returned.

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