NCLEX-PN
NCLEX Trainer Test 9 Questions
Extract:
Question 1 of 5
A nurse is performing the routine daily cleaning of a tracheostomy. During the procedure, the client coughs and displaces the tracheostomy tube. This negative outcome could have been avoided by
Correct Answer: C
Rationale: fastening clean tracheostomy ties before removing old ties. Fastening clean tracheostomy ties before removing old ones will ensure that the tracheostomy is secured during the entire cleaning procedure. The obturator is useful to keep the airway open only after the tracheostomy outer tube is coughed out. A second nurse is not needed. Changing the position may not prevent a dislodged tracheostomy.
Extract:
During the physical assessment, the nurse determines the need to perform the bulge Test .
Question 2 of 5
Which of the following statements, if made by the nurse, is BEST?
Correct Answer: A
Rationale: Strategy: Think about each answer choice. (1) correct-bulge Test confirms presence of fluid in the knee; client's leg should be extended and supported on the bed (2) observing curve of spine; scoliosis will cause lateral curve in the spine (3) unrelated to knee examination (4) Test s articulation of elbow
Extract:
Question 3 of 5
The nurse is planning care for an 8 year-old child. Which of the following should be included in the plan of care?
Correct Answer: A
Rationale: Encourage child to engage in activities in the playroom. According to Erikson, the school age child is in the stage of industry versus inferiority.
To help them achieve industry, the nurse should encourage them to carry out tasks and activities in their room or in the playroom.
Question 4 of 5
The multidisciplinary team decides to implement behavior modification with a client.
Correct Answer: A
Rationale: Consistency in applying the behavior modification plan is critical for success. Confirming that all staff members understand and comply ensures consistent implementation, reducing manipulation by the client or staff. While setting goals, choosing rewards, and scheduling reinforcement are important, they are secondary to ensuring staff alignment.
Question 5 of 5
A four-year-old is admitted with drooling and an inflamed epiglottis. During the assessment, the nurse would identify which of the following symptoms as indicative of an increase in respiratory distress?
Correct Answer: B
Rationale: increase in the respiratory rate is an early sign of hypoxia, also for tachycardia