NCLEX Questions, NCLEX Trainer Test 8 Questions, NCLEX-PN Qu

Extract:

A client with signs of increased intracranial pressure (ICP).

Question 1 of 5

In planning care for a client with signs of increased intracranial pressure (ICP), the nurse would include which of the following?

Correct Answer: D

Rationale: Strategy: Answers are a mix of assessments and implementations. Does this situation require assessment? Yes. (1) increases intracranial pressure (2) increases intracranial pressure (3) head of the bed should be elevated 15 to 30Â° to promote venous drainage (4) correct-assessment, cough or gag reflex and the swallowing reflex may be affected by the increased pressure; increases the incidence of aspiration

Extract:

Question 2 of 5

A clinic nurse is taking a health history from a 34-year-old man newly diagnosed with Buerger's disease. The nurse would expect the client's complaints to include

A. heart palpitations. B. dizziness when walking. C. blurred vision. D. digital sensitivity to cold.

Correct Answer: D

Rationale: vasculitis of blood vessels in upper and lower extremities

Extract:

A child admitted with failure to thrive has just had a positive sweat Test .

Question 3 of 5

The nurse would anticipate which of the following changes in the child's plan of care initially?

A. Administration of replacement enzymes. B. Administration of oxygen. C. A salt-restricted diet. D. Initiate intravenous therapy.

Correct Answer: A

Rationale: Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired? (1) correct-sweat Test is a positive finding for cystic fibrosis (2) no data in this situation to indicate that the child is having pulmonary problems (3) salt is increased in diet (4) no need for IV therapy based on the data in situation

Extract:

Question 4 of 5

Which of the following describes the proximodistal development in the infant?

A. The infant is able to raise his head before he is able to sit. B. The infant can control movements of his arms before he can control movements of his fingers. C. The infant responds to pain with his whole body before he can localize pain. D. The infant is able to make rudimentary vocalizations before using spoken words.

Correct Answer: B

Rationale: Proximodistal development refers to motor control progressing from the center of the body outward, meaning infants gain control of larger muscles (arms) before finer muscles (fingers).

Extract:

A client with signs of increased intracranial pressure (ICP).

Question 5 of 5

In planning care for a client with signs of increased intracranial pressure (ICP), the nurse would include which of the following?

A. Encourage coughing and deep breathing to prevent pneumonia. B. Suction the airway every 2 hours to remove secretions. C. Position the client in the prone position to promote venous return. D. Determine cough reflex and ability to swallow prior to administering PO fluids.

Correct Answer: D

Rationale: Strategy: Answers are a mix of assessments and implementations. Does this situation require assessment? Yes. (1) increases intracranial pressure (2) increases intracranial pressure (3) head of the bed should be elevated 15 to 30Â° to promote venous drainage (4) correct-assessment, cough or gag reflex and the swallowing reflex may be affected by the increased pressure; increases the incidence of aspiration