NCLEX-PN
NCLEX Trainer Test 8 Questions
Extract:
A 12-year-old girl whose tracheostomy tube inserted 2 days ago has been accidentally dislodged.
Question 1 of 5
The nurse should
Correct Answer: A
Rationale: Strategy: Answers are a mix of assessments and implementations. Does this situation require validation? No. Determine the outcome of the implementations. Remember ABCs. (1) correct-implementation, will secure the airway (2) implementation, will not provide for open airway (3) implementation, will not help with open airway (4) assessment, should be done after tracheostomy tube is replaced
Extract:
Question 2 of 5
An adult is admitted with histoplasmosis. What is most likely to be in the client's history because he has histoplasmosis?
Correct Answer: A
Rationale: Histoplasmosis is caused by inhaling Histoplasma spores, often found in bird or bat droppings, common in chicken farming environments, unlike shellfish, water, or milk.
Question 3 of 5
The nurse is caring for a client with a chest tube. On the second postoperative day, the chest tube accidentally disconnects from the drainage tube. The first action the nurse should take is
Correct Answer: D
Rationale: Immediate steps should be taken to prevent air from entering the chest cavity. Lung collapse may occur if air enters the chest cavity. Clamping the tube close to the client's chest is the first action to take, followed by health care provider notification.
Question 4 of 5
The nurse is caring for a client with a history of depression who is receiving venlafaxine (Effexor) 75 mg PO bid. Which of the following symptoms should the nurse report immediately?
Correct Answer: C
Rationale: Suicidal thoughts are a medical emergency with venlafaxine. Options A, B, and D are common side effects.
Question 5 of 5
A woman comes to the antepartum clinic for a routine prenatal examination. She is 12 weeks pregnant with her second child. Which of the following shows proper documentation of the client's obstetric history by the nurse?
Correct Answer: D
Rationale: Gravida 2, Para 1. Gravida describes a woman who is or has been pregnant, regardless of pregnancy outcome. Para describes the number of babies born past a point of viability.