NCLEX Daily Ten Question Practical Exercise 7

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. The intensive care unit nurse is supervising a coworker who is initiating a norepinephrine infusion for a client with septic shock. Which of the following actions by the coworker would demonstrate appropriate understanding of norepinephrine administration?

A. Waits to initiate norepinephrine until after blood cultures have been collected
B. Discontinues norepinephrine once the client’s mean arterial pressure is ≥65 mmHg
C. Starts the norepinephrine infusion at the lowest dose and titrates up every 3-5 minutes
D. Infuses the norepinephrine through an 18-gauge peripheral venous access device (VAD)

Correct Answer: C

Answer Explanation:

Vasopressors, including norepinephrine, are potent vasoconstrictors that can significantly impact cardiovascular function. Considerations when administering vasopressors include: Titrate vasopressors to achieve a specific hemodynamic goal, such as a mean arterial pressure (MAP). Start with the lowest effective dose and titrate based on the client’s blood pressure response [Choice 3]. This helps ensure the client receives the minimum dose necessary. Continuous blood pressure monitoring (e.g., with an arterial line) is essential when a client is on vasopressors to promptly detect changes and adjust the dose accordingly. Given the potential for extravasation (medication leaking into surrounding tissue), norepinephrine should be administered through a central venous access device (CVAD) rather than a peripheral venous access device (VAD).

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2. The nurse is screening clients for those at risk for colorectal cancer. At highest risk for colorectal cancer is the client who?

A. has dysphagia after experiencing a stroke
B. takes ibuprofen daily for chronic joint pain
C. consumes a diet high in red and processed meats
D. lost 200 lbs (90.7 kg) after a gastric bypass surgery

Correct Answer: C

Answer Explanation:

Colorectal cancer (CRC) originates in the colon or rectum. Several risk factors can increase risk for colorectal cancer:
Older age
Inflammatory bowel disease (IBD) (i.e., Crohn disease, ulcerative colitis)
Personal or family history of colorectal polyps or colorectal cancer
Genetic mutations (e.g., Lynch syndrome)
Diet low in fiber, fruits, and vegetables, or high in red or processed meats. Processed meats (bacon, sausages, hot dogs) have carcinogenic preservatives and chemicals.
Being sedentary or obese
Alcohol and tobacco use

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3. The nurse is administering an enema to a client when the client reports painful cramping. Which of the following actions should the nurse take?

A. Change the client’s position to prone.
B. Advance the tube further into the colon.
C. Pause instillation and lower bag before resuming.
D. Discontinue instillation and notify health care provider.

Correct Answer: C

Answer Explanation:

Enemas instill fluid into the rectum to break up fecal matter and stretch the rectum, stimulating peristalsis and defecation. Enemas are used to relieve constipation or to prepare for procedures like a colonoscopy. The nurse should begin administration by holding the bag of solution at the client’s hip level and slowly raising it higher. The higher the bag is held, the faster the solution will flow. Cramping may occur during enema administration as the enema distends the colon. If the client experiences discomfort, the nurse should pause and lower the bag before resuming to slow the rate.

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4. The nurse is caring for multiple clients in the emergency department. Which of the following client conditions would require the nurse to implement droplet precautions? Select all that apply.

A. Pulmonary tuberculosis with hemoptysis
B. Herpes simplex virus lesions on the mouth and nose
C. Diarrhea with stool culture positive for E. coli O157.H7
D. Myalgias, chills, rigors, and a productive cough for 2 days
E. Sore throat with culture positive for group A Streptococcus

Correct Answer: D E

Answer Explanation:

Droplet precautions prevent transmission of pathogens that are spread via large respiratory droplets produced when a person coughs, sneezes, or talks. These droplets can travel short distances (typically up to 3 ft [1 m]) and come into contact with the mucous membranes of another person.
Droplet precautions require staff and visitors to wear surgical masks when entering the room. Additionally, the client should be placed in a private room or be cohorted with another client with the same infection. The client should also wear a mask during transport outside the room.
Clients with viral respiratory symptoms (e.g., myalgias, chills, rigors, cough) are placed on droplet isolation until infectious status can be confirmed (e.g., through testing for influenza or SARS-CoV-2).
Group A Streptococcus (GAS), which causes strep throat, is also spread via respiratory droplets and would require droplet precautions.

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5. The nurse is planning a staff education program about tuberculosis (TB). Which of the following information should the nurse include?

A. Two clients with TB can share the same room.
B. Clients should be placed in a positive pressure room.
C. A surgical mask must be worn within 6 feet of the client.
D. Clients need to wear a surgical mask when being transported.

Correct Answer: D

Answer Explanation:

Airborne precautions are used with pathogens, like tuberculosis (TB), that spread through small airborne droplets and remain suspended in the air for extended periods (e.g., talking, coughing, sneezing). When transport outside the client’s room is required, the client should wear a surgical mask to prevent pathogen spread.

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