NCLEX-PN
NCLEX-PN Practice Questions Quizlet Questions
Extract:
When assessing an individual with a spontaneous pneumothorax, there is a danger of mediastinal shift.
Question 1 of 5
Mediastinal shift is described as:
Correct Answer: A
Rationale: Mediastinal shift involves tracheal deviation to the unaffected side due to pressure imbalance.
Extract:
Question 2 of 5
The measurement and documentation of vital signs is expected for clients in a long term facility. Which staff type would it be a priority to delegate these tasks to?
Correct Answer: C
Rationale: The measurement and recording of vital signs may be delegated to UAP. This falls under the umbrella of routine task with stable clients. Other considerations for delegation of care to UAP would be: Who is capable and is the least expensive worker to do each task?
Extract:
The client with COPD has orthopnea.
Question 3 of 5
The nurse is aware that one of the following is a correct description of orthopnea:
Correct Answer: D
Rationale: Orthopnea is eased by sitting upright, reducing lung compression.
Extract:
Question 4 of 5
A toddler is having a tonic-clonic seizure. What should the nurse do first?
Correct Answer: C
Rationale: During a seizure, the nurse's first priority is to protect the child from injury.
To prevent injury caused by uncontrolled movements, the nurse must remove objects from the child's surroundings and pad objects that can't be removed. Restraining the child or placing an object in the child's mouth during a seizure may cause injury. Once the seizure stops, the nurse should check for breathing and, if indicated, initiate rescue breathing.
Question 5 of 5
The nurse is administering iron by the $\mathrm{Z}$ track method. Which technique would the nurse utilize to prevent tracking of the medication?
Correct Answer: D
Rationale: The $0.2 \mathrm{ml}$ of air that would be administered after the medication with an intramuscular injection would allow the medication to be dispersed into the muscle. In the answer A, the muscle is small. Answer C is an incorrect procedure, and answer B doesn't help with prevention of tracking.