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Questions 158

NCLEX-RN

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Extract:


Question 1 of 5

The nurse is making room assignments for four obstetrical clients. If only one private room is available, it should be assigned to:

Correct Answer: B

Rationale: Preeclampsia requires close monitoring due to risks like seizures or stroke, making a private room essential for a primigravida with this condition.

Question 2 of 5

Which of the following would the nurse expect to find following respiratory assessment of a client with advanced emphysema?

Correct Answer: A

Rationale: Distant breath sounds are characteristic of emphysema due to increased anteroposterior chest diameter, overdistention, and air trapping.

Question 3 of 5

A family is experiencing changes in their lifestyle in many ways. The invalid grandmother has moved in with them. The couple have a 2-year-old son by their marriage, and the wife has two children by her previous marriage. The older children are in high school. In applying systems theory to this family, it is important for the nurse to remember which of the following principles?

Correct Answer: B

Rationale: Any change in any part of the system affects all other parts.

Question 4 of 5

Which play activity is best suited to the gross motor skills of a toddler?

Correct Answer: B

Rationale: Playing with a ball encourages gross motor skills like kicking, throwing, and running, suitable for a toddler's developmental stage. The other activities focus more on fine motor skills or require advanced coordination.

Question 5 of 5

A physician tells the nurse that he wants to orally intubate a client with a No. 8 endotracheal tube. The finding of normal breath sounds on the right side of the chest and diminished, distant breath sounds on the left side of the chest of a newly intubated client is probably due to:

Correct Answer: C

Rationale: The right mainstem bronchus is most frequently intubated in error because the angle of the right mainstem bronchus is very small as compared with that of the left mainstem bronchus. Because ventilation is only occurring on the right side, the nurse would auscultate diminished and distant breath sounds on the left.

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