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NCLEX Exam Practice Question of the Week - 9/12/18
The nurse is caring for a client who has just had implantation of an automatic internal cardioverter-defibrillator. The nurse should assess which item based on priority?
1. Anxiety level of the client and family
2. Presence of a MedicAlert card for the client to carry
3. Knowledge of restrictions on postdischarge physical activity
4. Activation status of the device, heart rate cutoff, and number of shocks it is programmed to deliver
Answer: 4
Rationale: The nurse who is caring for the client after insertion of an automatic internal cardioverter-defibrillator needs to assess device settings, similar to after insertion of a permanent pacemaker. Specifically, the nurse needs to know whether the device is activated, the heart rate cutoff above which it will fire, and the number of shocks it is programmed to deliver. The remaining options are also nursing interventions but are not the priority.
Practice Question Sourced From: Saunders Comprehensive Review for the NCLEX-RN Examination, 7th Edition (Cardiovascular System, Ch. 56, pg. 791, Question 683)
Getting involved in something takes time, effort and often times a financial commitment. Nursing school is a huge commitment in and of itself, so it’s easy to ask this question when it comes to leadership opportunities during nursing school.
Why should you get involved? Well, I can tell you from personal experience that it is worth the time, effort and energy! During my first semester of nursing school I was actively involved in my Student Nursing Association (SNA) chapter at my university. Before I knew it, I was approached by the previous President of the club and she encouraged me to run for a position and currently I am the President. I was not too sure about it at first because I was involved in other things and nursing school is already a big commitment. However, I am so glad that I chose to run because now I look back on all the opportunities that have come up because of my willingness to take a risk.
Some of the amazing benefits of being involved may include connections with local hospitals, professors, other staff at your university’s nursing school knowing who you are and willing to write recommendations, and the opportunity to attend conventions. In my time of being in a leadership position, I have been able to grow in my personal and professional skills as I interact with several different people to help coordinate events. I also have grown in public speaking as I have lead several meetings of up to 100 students, and spoke at different events in which hospital representatives attended. I have made a name for myself in the College of Nursing at my university and most professors know who I am and can see my work ethic by the amount of effort I put into the club. I have attended several conventions both on the state and national level and have been a delegate at both. I’ve been a part of national level change we make as the National Student Nurses’ Association when we vote on resolutions and join movements that are influential to give our patients the best quality of care we can.
Overall, I completely recommend getting involved because this blog post only scratches the surface of what I have gained from my time leading the SNA chapter at my university. I feel more qualified to take on the world of applying to several different hospitals as I have all this valuable experience under my belt. It may take some time and effort but it will pay off in the end!
The nurse witnessed a vehicle hit a pedestrian. The victim is dazed and tries to get up. A leg appears fractured. Which intervention should the nurse take?
1. Try to reduce the fracture manually.
2. Assist the victim to get up and walk to the sidewalk.
3. Leave the victim for a few moments to call an ambulance.
4. Stay with the victim and encourage him or her to remain still.
Answer: 4
Rationale: With a suspected fracture, the victim is not moved unless it is dangerous to remain in that spot. The nurse should remain with the victim and have someone else call for emergency help. A fracture is not reduced at the scene. Before the victim is moved, the site of fracture is immobilized to prevent
further injury.
Practice Question Sourced From: Version: Saunders Comprehensive Review for the NCLEX-RN Examination, 7th Edition (Musculoskeletal System, Ch. 64, pg. 952, Question 802)
NCLEX Exam Practice Question of the Week - 8/29/18
The nurse is reviewing the assessment data of a client admitted to the mental health unit. The nurse notes that the admission nurse documented that the client is experiencing anxiety as a result of a situational crisis. The nurse plans care for the client, determining that this type of crisis could be caused by which event?
1. Witnessing a murder
2. The death of a loved one
3. A fire that destroyed the client’s home
4. A recent rape episode experienced by the client
Answer: 2
Rationale: A situational crisis arises from external rather than internal sources. External situations that could precipitate a crisis include loss or change of a job, the death of a loved one, abortion, change in financial status, divorce, addition of new family members, pregnancy, and severe illness. Options 1, 3, and 4 identify adventitious crises. An adventitious crisis refers to a crisis of disaster, is not a part of everyday life, and is unplanned and accidental. Adventitious crises may result from a natural disaster (e.g., floods, fires, tornadoes, earthquakes), a national disaster (e.g., war, riots, airplane crashes), or a crime of violence (e.g., rape, assault, murder in the workplace or school, bombings, or spousal or child abuse).
Practice Question Sourced From: Version: Saunders Comprehensive Review for the NCLEX-RN Examination, 7th Edition (Crisis Theory and Intervention, Ch. 71, pg. 1038, Question 894)
NCLEX Exam Practice Question of the Week - 8/22/18
An oxygen delivery system is prescribed for a client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which oxygen delivery system would the nurse prepare for the client?
Rationale: The Venturi mask delivers the most accurate oxygen concentration. It is the best oxygen delivery system for the client with chronic airflow limitation such as chronic obstructive pulmonary disease, because it delivers a precise oxygen concentration. The face tent, aerosol mask, and tracheostomy collar are also high-flow oxygen delivery systems but most often are used to administer high humidity.
Practice Question Sourced From: Version: Saunders Comprehensive Review for the NCLEX-RN Examination, 7th Edition (Respiratory System, Ch. 54, pg. 731, Question 644)
NCLEX Exam Practice Question of the Week - 8/15/18
A client who just gave birth has three young children at home. She comments to the nursery nurse that she must prop the baby during feedings when she returns home because she has too much to do, and anyway holding babies during feedings spoils them. What is the nurse's best response?
1. "You seem concerned about time. Let's talk about it."
2. "That's up to you because you have to do what works for you."
3. "Holding the baby when feeding is important for development."
4. "It is not safe to prop a bottle. The baby could aspirate the fluid."
Answer: 1
Rationale: The nurse should suggest talking about the client's concern regarding the time. This opens up an area of communication to determine what really is troubling the mother about feeding her baby.
2 - The nurse is aware that propping the baby during feedings is not the bet method when using a bottle to feed an infant; the problem of time should be explored with the mother. 3 - Holding can be accomplished at times other than feeding periods; talking about the importance to development does not explore the client's feelings. 4 - "It is not safe to prop a bottle. The baby could aspirate the fluid" is true, but the mother should not be challenged so directly; a more gentle explanation should be offered.
Practice Question Sourced From: Version: Elsevier: Nursing Key Topics Review: Maternity (Nursing Care of the Family During the Postpartum Period, Ch. 14, pg. 227, Question 18)
A client has refused to eat more than a few spoonfuls of breakfast. The health care provider has prescribed that tube feedings be initiated if the client fails to eat at least half of a meal because the client has lost a significant amount of weight during the previous 2 months. The nurse enters the room, looks at the tray, and states, “If you don’t eat any more than that, I’m going to have to put a tube down your throat and get a feeding in that way.” The client begins crying and tries to eat more. Based on the nurse’s actions, the nurse may be accused of which violation?
1. Assault
2. Battery
3. Slander
4. Invasion of privacy
Answer: 1
Rationale: Assault occurs when a person puts another person in fear of harmful or offensive contact and the victim fears and believes that harm will result as a result of the threat. In this situation, the nurse could be accused of the tort of assault. Battery is the intentional touching of another’s body without the person’s consent. Slander is verbal communication that is false and harms the reputation of another. Invasion of privacy is committed when the nurse intrudes into the client’s personal affairs or violates confidentiality.
Practice Question Sourced From: Version: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 7e (Comprehensive Test, pg. 1060, Question 961)
A female victim of a sexual assault is being seen in the crisis center. The client states that she still feels “as though the rape just happened yesterday,” even though it has been a few months since the incident. Which is the most appropriate nursing response?
1. “You need to try to be realistic. The rape did not just occur.”
2. “It will take some time to get over these feelings about your rape.”
3. “Tell me more about the incident that causes you to feel like the rape just occurred.”
4. “What do you think that you can do to alleviate some of your fears about being raped again?”
Answer: 3
Rationale: The correct option allows the client to express her ideas and feelings more fully and portrays a nonhurried, nonjudgmental, supportive attitude on the part of the nurse. Clients need to be reassured that their feelings are normal and that they may express their concerns freely in a safe, caring environment. Option 1 immediately blocks communication. Option 2 places the client’s feelings on hold. Option 4 places the problem solving totally on the client.
Practice Question Sourced From: Version: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 7e (Crisis Theory and Intervention, Ch. 71, pg. 1039, Question 905)
NCLEX Exam Practice Question of the Week - 7/25/18
A nurse is evaluating a parent's understanding of his child's peritoneal dialysis. Which information in the parent's response indicates an understanding of the purpose of the procedure?
1. Reestablishes kidney function
2. Cleans the peritoneal membrane
3. Provides fluid for intracellular spaces
4. Removes toxins in addition to other metabolic wastes
Answer: 4
Rationale: Peritoneal dialysis uses the peritoneum as a selectively permeable membrane for diffusion of toxins and wastes from the blood into the dialyzing solution. 1 - Peritoneal dialysis acts as a substitute for kidney functions; it does not reestablish kidney function. 2 - The dialysate does not clean the peritoneal membrane; the semipermeable membrane allows toxins and wastes to pass into the dialysate within the abdominal cavity. 3 - Fluid in the abdominal cavity does not enter the intracellular compartment.
Practice Question Sourced From: Version: Elsevier: Nursing Key Topics Review: Pediatrics (Care of the Child with Genitourinary and Reproductive Problems, Ch. 15, pg. 289, Question 18)
NCLEX Exam Practice Question of the Week - 7/18/18
The nurse has given the client instructions about crutch safety. Which statement indicates that the client understands the instructions? Select all that apply.
1. “I should not use someone else’s crutches.”
2. “I need to remove any scatter rugs at home.”
3. “I can use crutch tips even when they are wet.”
4. “I need to have spare crutches and tips available.”
5. “When I’m using the crutches, my arms need to be completely straight.”
Answer: 1, 2, 4
Rationale: The client should use only crutches measured for the client. When assessing for home safety, the nurse ensures that the client knows to remove any scatter rugs and does not walk on highly waxed floors. The tips should be inspected for wear, and spare crutches and tips should be available if needed. Crutch tips should remain dry. If crutch tips get wet, the client should dry them with a cloth or paper towel. When walking with crutches, both elbows need to be flexed not more than 30 degrees when the palms are on the handle.
Practice Question Sourced From: Version: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 7e (Musculoskeletal System, Ch. 64, pg. 953, Question 810)
NCLEX Exam Practice Question of the Week - 7/11/18
A client with Guillain-Barr e syndrome has ascending paralysis and is intubated and receiving mechanical ventilation. Which strategy should the nurse incorporate in the plan of care to help the client cope with this illness?
1. Giving client full control over care decisions and restricting visitors
2. Providing positive feedback and encouraging active range of motion
3. Providing information, giving positive feedback, and encouraging relaxation
4. Providing intravenously administered sedatives, reducing distractions, and limiting visitors.
Answer: 3
Rationale: The client with Guillain-Barre syndrome experiences fear and anxiety from the ascending paralysis and sudden onset of the disorder. The nurse can alleviate these fears by providing accurate information about the client’s condition, giving expert care and positive feedback to the client, and encouraging relaxation and distraction. The family can become involved with selected care activities and provide diversion for the client as well.
Practice Question Sourced From: Version: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 7e (Neurological System, Ch. 62, pg. 918, Question 783)
A client has experienced pulmonary embolism. The nurse should assess for which symptom, which is most commonly reported?
1. Hot, flushed feeling
2. Sudden chills and fever
3. Chest pain that occurs suddenly
4. Dyspnea when deep breaths are taken
Answer: 2
Rationale: The nurse who is in contact with a client with tuberculosis should wear an individually fitted particulate respirator. The nurse also would wear gloves as per standard precautions. The nurse wears a gown when the possibility exists that the clothing could become contaminated, such as when
giving a bed bath.
Practice Question Sourced From: Version: Silvestri: Saunders Comprehensive Review for the NCLEX-RN Examination, 7e (Respiratory System, Ch. 54, pg. 731, Question 638)
“Begin with the end in mind” as said by Steven Covey, is one of my favorite quotes. In nursing school, we often get so wrapped up in focusing on the present and just “getting through” it all, that we tend to forget to also start preparing for the next step—getting a nursing job! Although the job outlook for nursing is positive, with the field expected to grow about 15% from 2016-2026 (Bureau of Labor Statistics, 2018), this doesn’t necessarily make things any easier for ‘new grad’ nurses. Applying for new grad nurse positions is a competitive process and should be approached with strategy and extra care. There are many aspects of the application process that the student nurse should try their best to excel in and positively set themselves apart from the other applicants. Here is some advice directly from a nursing supervisor, an experienced charge nurse, and an experienced staff nurse who have all participated in the hiring of new grad nurses.
The Application
The application is the first thing seen by the hiring managers before they even consider bringing you in to interview you for a position. Having a strong resume that sets you apart from the average applicant will help you better your chances of making it further in the application process. Here is some advice on how to construct your resume and a few things that hiring managers look for that makes your resume stand out.
· A new grad resume should be about one page; most new grads have little to no experience, so a lengthy resume is unnecessary and most likely won’t be read because there is just not enough time. The resume should be professional and formatted correctly; most schools have a resource center where someone can read over the resume and help them edit it for free!
· Relevant Experience- new grad nurses who have worked as techs/ student nurses before have a better chance of getting hired because they have experience in the field that will benefit their transition. Make sure you try to get a tech or student nurse job as soon as possible while in nursing school.
· GPA- although GPA isn’t the only factor, it is important when it comes to certain units and hospitals.
· School and Level of education- Some hiring managers look for certain schools because they know them well and have had success with those students in the past. Furthering your education is exponentially important; especially at a Magnet Status hospital BSNs are strongly preferred. You should continue to gather certifications and increase your education throughout your career.
· Leadership and Membership- Memberships to organizations (such as student nurse association and/or student memberships to specialty related fields) really stand out to hiring managers because it shows your dedication and involvement in the nursing field.
· Apply as soon as possible! Don’t wait until the last minute to apply to posted jobs; be proactive.
· Apply to the place you work at first- internal applicants are often preferred because they know you and the lateral transfer process is easier.
The Interviewing Process
First impressions are extremely important and can make or break how the rest of the interview progresses. Here are a few things you should keep in mind before and during an interview, to make your interview the best it can be.
· When you show up, show up early; if you are on time, you are already late.
· Dress appropriately-Business casual (from head-to-toe) is the way to go at the initial interview; leave the low-cut shirts, tight pants, flip-flops, jeans, acrylic nails, colorful hair, and exercise attire (ie: Yoga Pants) at home that day. Wear something modest, appropriate, and professional.
· Shake the manager’s hand and make eye contact; these are professional behaviors that are looked for during an interview.
· Do your homework- Know about the hospital or facility you are applying to work at; it is great when you are knowledgeable about the place, it shows your level of interest.
· Be prepared- Bring any supplemental material, licenses, or anything else you may need or be asked for during the interview.
· Silence isn’t always a bad thing! If the manager asks you a question, take some time to really think about a strong answer, if you need a minute say so, don’t just answer just to answer.
· Be confident but have humility when appropriate. We all have room to grow; acknowledge that and grow build on it.
· Be flexible! As a nurse (especially the new nurse) you will absolutely have to work weekends and holidays, and most likely even night shifts. Know that this won’t necessarily be permanent, but you will need to work where you are needed; a manager will be more likely to hire you if there are less “demands” to your schedule.
· Ask questions! The interview isn’t just for you; it’s also you are interviewing the place in a way. The only way to know the answer to if you would be a good fit for a place is if you find out all the information you can.
The Final Steps
After it is all said and done, then comes the worst part: the waiting game! Although in a perfect world, it would be amazing to be offered the job ‘on the spot’, often times the hiring manager would prefer to meet and interview all of their options and then compare everyone so they can pick the new grad nurse(s) that they feel is the best fit. After an interview, it is always a good practice to send a follow up “Thank you” email. About a day after the interview, follow up with the hiring manager and thank them for their time and express how much you enjoyed the opportunity to speak with them. Finally, if there is a follow up call asking for further information, respond politely and promptly. These are all things that will positively affect the outcome.
Hopefully following these tips will help you get the nursing job of your dreams! Good luck to those in the application process and those who are approaching it. I want to give a special thanks to Barbara McGuinness, RN, MS, the Nursing Supervisor on the Heart and Vascular Unit at AAMC, Laura Kistler, RN, BSN, B-C, Charge Nurse on the Heart and Vascular Unit, and Diana Cole RN, BSN, an experienced staff nurse on the Heart and Vascular Unit for their help and feedback with this post.
NCLEX Exam Practice Question of the Week - 6/28/18
Nurses who care for the terminally ill apply the theories of Kübler-Ross in planning care. According to Kübler-Ross, individuals who experience a terminal illness go through a grieving process. Place the stages of this process in the order identified by Kübler-Ross.
Rationale: 2 - The initial response is shock, disbelief, and denial, and the client seeks additional opinions to negate the diagnosis. 1 - When negating the diagnosis is unsuccessful, the client becomes angry and negative. 3 - Bargaining for wellness follows in an attempt to prolong life. 4 - As the reality of the situation becomes more apparent, depression sets in and the client may become withdrawn. 5 - Acceptance is the final stage of grieving; this stage may never be achieved.
We have all heard that nursing students have no lives, seen the t-shirts that state "I can't I'm in nursing school", or heard people say "I'll sleep when school is over". However, I want to give you hope that this chaotic lifestyle isn't always the reality. I was not willing to simply stop living when I started nursing school.
I have always lead a pretty jam packed life. From working part time in high school, participating in sports, and taking AP classes. Then into college with 18 units, joining clubs and playing on intramural sports teams. My life has been full, but never overwhelming. Neither was my transition from my exhaustive prerequisites into nursing school. Time management has always been an area of my life I had to stay on top of.
Nursing school did change a few things. I no longer looked at assignments and did them in the order they were due. Instead, I learned to work as far ahead as possible. If I found myself with a free afternoon I would write a paper even if it was not due for another month. The syllabus usually does a great job outlining assignments and utilizing it to get as many projects done ahead of time really relieves a lot of stress. I also learned I needed more than just one day to study for an exam. On days I had extra time in the morning I would review PowerPoints from that week to keep the information fresh.
The most important part of balance is making sure you allow time for things you enjoy so you don't get burned out. Saturday's were my day off. I would sleep in, play ultimate frisbee, go out for lunch, volunteer at my church and then go out in the evening. I made sure that I saw friends outside my nursing world by getting lunch/dinner with them throughout the week. I strategized my study habits to ensured that if there was an event I wanted to go to, even one that was the night before an exam, I had studied sufficiently ahead of time.
Now you might be thinking this girl must never have slept. I usually managed 6 hours of sleep a night.
I pray that this gives you hope and relieves some of your fears if you are an incoming nursing student. Plan out your days, use your time wisely, and schedule in fun things! Spend an hour at lunch with a friend. Take a nap when you need one. Say yes to going to the movies on Friday. Just ensure that you are aware of your time spent and that you are focused when you are studying. Bring balance into your life.
“Wherever you are be all there” Jim Elliot
NCLEX Exam Practice Question of the Week - 6/20/18
What treatment should the nurse suggest to an adolescent with type 1 diabetes if an insulin reaction is experienced while at a basketball game?
1. "Call your parents immediately."
2. "Buy a soda and hamburger to eat."
3. "Administer insulin as soon as possible."
4. "Leave the arena and rest until the symptoms subside."
Answer: 2
Rationale: The adolescent needs immediate and easily absorbable glucose, such as soda, and long-lasting complex carbohydrates and protein, which are supplied by the bun and hamburger.
1 - Calling the parents can be done after some glucose has been ingested; otherwise, the adolescent's hypoglycemia can become severe. 3 - Extra insulin will further aggravate the problem. 4 - Leaving is unsafe; appropriate intervention is necessary
Practice Question Sourced From: Version: Elsevier: Nursing Key Topics Review: Pediatrics (Family-Centered Care of the School-Age and Adolescent Child, Ch. 11, pg. 183, Question 21)
Nursing school is one of the most intense and stressful programs for students. Many hear how time-consuming and difficult it may be, but you never understand it until you have jumped off the diving board, head first, into your nursing school curriculum. Nurses have their own language, including nursing diagnosis, medical terminology, and the many abbreviations for all the above. It is important to remember, that it is difficult just to begin nursing school. If you are in your first semester, give yourself a pat on the back; you made it through all the prerequisites and entrance exams.
As you continue through your program, you will experience many accomplishments, a little anxiety, and possibly, a few bad days. It’s important to remember that we all have bad days. There is not a single person going through nursing school right now that will not have a bad day. Bad days are okay. You might have a bad day because you didn’t score as well on a test as you would have liked. Or, you did not pass your checkoff or dreaded simulation on your first try. Maybe, you had a tough patient during clinicals and it pulled at your heartstrings. No matter the reason, you have bad days because you care about your education and most of all, your future career. You care because you know how important your education is, because you desire to be the best nurse you can to provide exceptional care to your patients. So, when you have that awful day, tears are streaming down your face, and you consider giving up, just know that you are right where you are supposed to be.
On these bad days, give yourself a break. Find a way to relieve some of your stress, like going to the gym, taking a yoga class, cooking some comfort food, spending time with your family or friends, or escaping into a good (non-nursing) book. Have a friend that you call to vent to or go out to dinner with a group of your friends, they are there to celebrate the good times and support you during the rough days. Take the night off and remember the next day will be a new day, full of opportunity.
When you awake the next day (hopefully refreshed) take a minute to evaluate the previous day. What made it so bad? Did you not do well on that dreaded nursing school test? (Don’t worry, those Select All That Apply Questions make us all cringe.) Evaluate how you studied and change what didn’t work. This is trial and error. For me, using Elsevier Adaptive Quizzing helped ensure I really knew the information. After I mastered the concepts, I began my practice questions to prepare for the test.
If you didn’t pass your checkoff/simulation, know you are not alone! Many don’t pass the first time, and that’s okay. The reason you have simulations are to prepare you for “real life” when you have graduated, and you have that beautiful license number that makes you a Registered Nurse. These can be difficult because they want to make sure you are prepared to assess and care for your patients in the field. If you didn’t pass the first time, go practice! Remember that you are still learning, and you are preparing yourself to be a safe, exceptional nurse.
When you have a bad day because a patient really tugged at your heartstrings, know that this is because you truly care. Compassion and caring is something they cannot teach you in nursing school but are qualities that will make you a great nurse. Find a stress relief outlet like we discussed before and continue to use this as you graduate and become a nurse.
Bad days are okay! With the bad days, you will have many good days. Keep your eye on your long-term goals and know that you are one day further than you were yesterday. Keep pushing forward and be proud of your accomplishments, there are more to come!
