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Study NCLEX PN Questions with Answers 96th Edition
1. A nurse is caring for a client at home who has had a tracheostomy tube for several months. The nurse monitors the client for complications associated with the long-term tracheotomy and suspects tracheoesophageal fistula if which of the following is noted in the client?
A. Abdominal distention
B. Purulent drainage around the tracheotomy site
C. Excessive secretions from the tracheotomy site
D. Inability to pass a suction catheter through the tracheotomy
Answer: A. Abdominal distention
Rationale: Necrosis of the tracheal wall can lead to an artificial opening between the posterior trachea and the esophagus. This problem is called tracheoesophageal fistula. The fistula allows air to escape into the stomach, causing abdominal distention. It also can cause aspiration of gastric contents. Option 2 may indicate an infection. Option 3 may indicate the need for more frequent suctioning. Option 4 may indicate an obstruction of some sort or the presence of bronchoconstriction.
Test-Taking Strategy: A fistula is an artificial opening. Remembering that tracheoesophageal indicates trachea to esophagus, review the options and use the process of elimination. If you think of air moving from the trachea to the esophagus, you will know that abdominal distention occurs with this condition. Review the signs of this complication if you had difficulty with this question.
Level of Cognitive Ability: Analysis
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Data Collection
Content Area: Adult Health/Respiratory
Reference: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p. 1779.
2. A nurse is observing a student preparing to suction a pediatric client through a tracheostomy. The nurse intervenes if the student verbalizes to:
A. Use a twisting motion on the catheter when withdrawing the catheter
B. Apply continuous suction when withdrawing the catheter
C. Limit insertion and suctioning time to 5 seconds
D. Reoxygenate the child between suction catheter passes
Answer: B. Apply continuous suction when withdrawing the catheter
Rationale: The nurse would apply intermittent (not continuous) suction on the catheter during withdrawal to prevent trauma to the mucosa. Options 1, 3, and 4 represent correct interventions regarding this procedure.
Test Taking Strategy: Note the key word intervenes. This word indicates a false response question and that you need to select the incorrect student statement. Noting the word “continuous” in option 2 will direct you to this option. If you are unfamiliar with the procedure, review this content.
Level of Cognitive Ability: Analysis
Client Needs: Safe, Effective Care Environment
Integrated Process: Nursing Process/Implementation
Content Area: Leadership/Management
Reference: Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 374.
3. A nurse is preparing to administer an acetaminophen (Tylenol) suppository to a child. The nurse plans to:
A. Position the child on the right side with the left leg flexed
B. Ask the child to hold the breath during insertion of the suppository
C. Insert the suppository 1 to 2 cm into the rectum
D. Ask the child to expel the suppository after it has been inserted
Answer: C. Insert the suppository 1 to 2 cm into the rectum
Rationale: When administering a suppository to a child, the child should be positioned on the left side with the right leg flexed. The child should be asked to take a deep breath to further relax the sphincter. The suppository is gently inserted past the internal sphincter and the distance required to place the medication is approximately 1 to 2 cm. After insertion, the buttocks should be held together until the urge to expel the suppository has passed.
Test-Taking Strategy: Focus on the procedure—the appropriate method for administering a rectal suppository to a child. Visualizing the procedure and noting that the question is addressing the pediatric client will direct you to option C. If you are unfamiliar with this procedure, review this content.
Level of Cognitive Ability: Application
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Planning
Content Area: Child Health
References: Leifer, G. (2003). Introduction to maternity & pediatric nursing (4th ed.). Philadelphia: W.B. Saunders, p. 514.
McKinney, E., James, S., Murray, S., & Ashwill, J. (2005). Maternal-child nursing (2nd ed.). St. Louis: Elsevier, p. 980.
4. A nurse is reviewing the record of a child admitted to the hospital with nephrotic syndrome. Which finding would the nurse expect to note documented in the record?
A. Hyperalbuminemia
B. Weight loss
C. Increased appetite
D. Proteinuria
Answer: D. Proteinuria
Rationale: The term nephrotic syndrome refers to a kidney disorder characterized by proteinuria, hypoalbuminemia, and edema. The child experiences fatigue, anorexia, increased weight, abdominal pain, and a normal blood pressure.
Test Taking Strategy: Use the process of elimination. Recalling that this syndrome is related to the renal system will assist in directing you to option D. If you are unfamiliar with the signs associated with this disorder, review this content.
Level of Cognitive Ability: Comprehension
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Data Collection
Content Area: Child Health
Reference: Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 247.
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