NCLEX-RN Test 1 NGN Correctly Answered.

NCLEX-RN Test 1 NGN Correctly Answered. 1. The nurse wit- nesses the col- lapse of a child while outdoors. The child is not breathing and has a pulse of 50/min. The nurse calls emer- gency services and initiates res- cue breathing. After 2 min- utes of rescue breaths, the child is still not breath- ing and is pale with a pulse of 30/min. What is the nurse's next action? 2. The charger nurse is respon- sible for mak- ing room as- signments multi- 1. Initiate chest compressions Rescue breathing is performed at a rate of 1 breath every 2-3 seconds. If the pulse remains 60/min and there are signs of poor perfusion (skin pallor), the nurse should initiate chest compressions and reassess the pulse every 2 minutes 3. Client who had a bowel resection 1 day ago and client with asthma exacerba- tion. When making room assignments, it is important to remember that a client with an active or suspected infection should not be paired with a client who has ple clients. Which a fresh surgical wound or is immunocompromised. A client having an asthma pari of client as- signments to a shared room is appropriate? exacerbation does not have an infection and is not at risk for spreading infection to a client who had a recent bowel resection surgery. 3. The clinic nurse is assessing a client who is be- ing treated for depression and suicidal ideation. Which client statement best 2. "I plan to attend my grandchild's graduation next month" Clients receiving treatment for depression and suicidal ideation must be carefully monitored for indications of increasing suicidal intent. During a client interview, the nurse should assess: - Access to psychiatric medications - Availability of help during a crisis (counselor, family) - Future goals and plans indicates that the - Home and environment risks client is not cur- rently at risk for suicide? 4. The nurse is car- ing for a client - Overall attect and level of energy - Possible access to weapons Clients who articulate long-term personal goals and family milestones are less likely to attempt death by suicide 1. Administer potassium supplement who had an ante- In ventricular trigeminy, premature ventricular contractions (PVCs) occur every rior wall myocar- dial infarction 2 days ago. The telemetry techni- cian notifies the nurse at 8:30 AM that the client is in ventricular trigeminy. What is the nurse's priority interven- tion? 5. third heartbeat. Myocardial injury (eg, myocardial infarction) predisposes the client to ectopy (eg, PVCs), which increases the client's risk for lethal dysrhythmias (eg, ventricular tachycardia). PVCs are caused and/or exacerbated by hypoxia, electrolyte imbalances, emotional stress, stimulants, fever, and exercise. This client's morning laboratory results show hypokalemia (potassium 3.5 mEq/L [3.5 mmol/L]); therefore, the priority is treatment of the underlying cause of the ectopy by administering the prescribed potassium replacement (Option 1). Health care providers (HCPs) often prescribe electrolyte replacement algorithms to clients at risk for electrolyte imbalances (eg, myocardial injury, receiving di- uretics) unless a contraindication exists (eg, serum creatinine 1.5 mg/dL [133 µmol/L], anuric, weight 99.2 lb [45 kg]). The nurse cares for a client with a terminal dis- ease who creat- ed a do not at- tempt resuscita- tion (DNAR) di- rective. The client stops breath- ing and los- es their pulse. The client's adult child states, "Please, do what- ever you can to save them!" Which interven- tion is appropri- ate? 6. The nurse in 3. Explain the client's resuscitation directive to the client's child