Nursing Nclex Practice

1. A nurse is teaching cardiopulmonary resusitation to a group of community members. The nurse asks a member fo the group to describe the reswon why blind finger sweeps are avoided in infants. The nurse determines that the person understands this reason if the person makes which statement:

The obuect ma be forced back further into the throat

The mouth is too small to see the object

The object may have been swallowed

The infant may bite down on the finger

Blind finger sweeps are avoided in infants because the object may be forced back further into the throat. This can potentially cause choking or blockage of the airway, making the situation worse. It is important to use proper techniques and equipment to remove any foreign objects from an infant's airway.

Explanation

Blind finger sweeps are avoided in infants because the object may be forced back further into the throat. This can potentially cause choking or blockage of the airway, making the situation worse. It is important to use proper techniques and equipment to remove any foreign objects from an infant's airway.

2. A nurse is preparing to attempt to relieve an airway obstruction in a 3 year old conscious child. The nurse performs this maneuver by palcing the hands between the:

Umbilicus and the groin

Groin and the abdomen

Umbilicus and the ziphoid process

Lower abdomen and the chest

The correct answer is "Umbilicus and the ziphoid process." When attempting to relieve an airway obstruction in a conscious child, the nurse performs the Heimlich maneuver by placing the hands between the umbilicus (belly button) and the ziphoid process (the bottom part of the sternum or breastbone). This maneuver involves applying upward pressure to the abdomen to help dislodge the obstruction and allow the child to breathe again. Placing the hands in this specific location ensures that the pressure is applied effectively and helps to clear the airway.

Explanation

The correct answer is "Umbilicus and the ziphoid process." When attempting to relieve an airway obstruction in a conscious child, the nurse performs the Heimlich maneuver by placing the hands between the umbilicus (belly button) and the ziphoid process (the bottom part of the sternum or breastbone). This maneuver involves applying upward pressure to the abdomen to help dislodge the obstruction and allow the child to breathe again. Placing the hands in this specific location ensures that the pressure is applied effectively and helps to clear the airway.

3. A nurse witnesses a neighbor's husband sustain a fall from the roof of his house. The nurse rushes to the victim and determines the need to open the airway. The nurse opens the aireay in this victim by using whci appropriate method?

Head tilt-chin lift

Flexed position

Modified head tilt-chin lift

Jaw thrust maneuver

The nurse opens the airway in this victim by using the jaw thrust maneuver. This method is appropriate in cases where there is a suspected spinal injury, as it allows for the opening of the airway without hyperextending the neck. By using the jaw thrust maneuver, the nurse can lift the jaw forward without moving the neck, ensuring that the airway remains clear and unobstructed.

Explanation

The nurse opens the airway in this victim by using the jaw thrust maneuver. This method is appropriate in cases where there is a suspected spinal injury, as it allows for the opening of the airway without hyperextending the neck. By using the jaw thrust maneuver, the nurse can lift the jaw forward without moving the neck, ensuring that the airway remains clear and unobstructed.

4. A nurse is performing cardiopulmonar resuscitation on an infant. When performing chest compressions, the nurse understands that the compression rate is at least:

60 times a minute

80 times a minute

100 times a minute

120 times a minute

During cardiopulmonary resuscitation (CPR) on an infant, the nurse should perform chest compressions at a rate of 100 times per minute. This ensures adequate circulation and oxygenation to the infant's vital organs. Compressions that are too slow may not provide enough blood flow, while compressions that are too fast can impede blood flow and decrease the effectiveness of CPR. Therefore, a compression rate of 100 times per minute is considered optimal for infant CPR.

Explanation

During cardiopulmonary resuscitation (CPR) on an infant, the nurse should perform chest compressions at a rate of 100 times per minute. This ensures adequate circulation and oxygenation to the infant's vital organs. Compressions that are too slow may not provide enough blood flow, while compressions that are too fast can impede blood flow and decrease the effectiveness of CPR. Therefore, a compression rate of 100 times per minute is considered optimal for infant CPR.

5. A nursing instructior teaches a group of students about basic life support. The instructor asks a student to identify the most appropriate location to assess the pulse of an infant under 1 year of age. Which of the following if stated by the student, would indicate that the student understands the appropriate procedure:

Carotid

Popliteal

Radial

Brachial

The correct answer is Brachial. The brachial pulse is the most appropriate location to assess the pulse of an infant under 1 year of age. The brachial artery is located in the upper arm, and it is easily accessible in infants. Assessing the pulse in this location allows for accurate measurement and evaluation of the infant's circulation and perfusion.

Explanation

The correct answer is Brachial. The brachial pulse is the most appropriate location to assess the pulse of an infant under 1 year of age. The brachial artery is located in the upper arm, and it is easily accessible in infants. Assessing the pulse in this location allows for accurate measurement and evaluation of the infant's circulation and perfusion.

6. A nurse is performing CPR on an adult client. The nurse understands that, when chest compressions are performed, the sternum should be depressed:

1/2 to 3/4 inch

3/4 to 1 inch

1 1/2 to 2 inches

2 to 3 inches

When performing CPR on an adult client, the nurse should depress the sternum 1 1/2 to 2 inches. This depth of compression is necessary to effectively pump blood through the heart and maintain circulation. Pressing too shallowly may not generate enough pressure to circulate blood, while pressing too deeply can cause damage to the internal organs. Therefore, the correct range of chest compression depth for an adult client is 1 1/2 to 2 inches.

Explanation

When performing CPR on an adult client, the nurse should depress the sternum 1 1/2 to 2 inches. This depth of compression is necessary to effectively pump blood through the heart and maintain circulation. Pressing too shallowly may not generate enough pressure to circulate blood, while pressing too deeply can cause damage to the internal organs. Therefore, the correct range of chest compression depth for an adult client is 1 1/2 to 2 inches.

7. A nurse on the day shift walks into a clients room and finds the client unresponsive. The client is not breathing and does not have a pulse, and the nurse immediately calls out for help. The next nursing action is which of the following:

Ventilate with a mouth to mask device

Start chest compressions

Give the client oxygen

Open the airway

In this scenario, the nurse has found the client unresponsive, not breathing, and without a pulse. These are signs of cardiac arrest, a life-threatening condition. The first and most critical action to take is to initiate chest compressions. Chest compressions help circulate oxygenated blood throughout the body, which is crucial to maintain vital organ function during cardiac arrest.

Explanation

In this scenario, the nurse has found the client unresponsive, not breathing, and without a pulse. These are signs of cardiac arrest, a life-threatening condition. The first and most critical action to take is to initiate chest compressions. Chest compressions help circulate oxygenated blood throughout the body, which is crucial to maintain vital organ function during cardiac arrest.

8. A nurse is performing basic life support(BLS) on a 6 year old child. The nurse delivers how many breaths per minute to the child:

12

16

14

20

During basic life support (BLS), the nurse delivers 20 breaths per minute to a 6-year-old child. This is because children require a higher respiratory rate compared to adults. The higher respiratory rate ensures adequate oxygenation and ventilation for the child, as their lungs are smaller and their metabolic demands are higher. Therefore, delivering 20 breaths per minute is necessary to maintain the child's oxygen levels and support their breathing during BLS.

Explanation

During basic life support (BLS), the nurse delivers 20 breaths per minute to a 6-year-old child. This is because children require a higher respiratory rate compared to adults. The higher respiratory rate ensures adequate oxygenation and ventilation for the child, as their lungs are smaller and their metabolic demands are higher. Therefore, delivering 20 breaths per minute is necessary to maintain the child's oxygen levels and support their breathing during BLS.

9. A nurse is performing cardiopulmonary resuscitation(CPR) on an adult client. When performing chest compressins, the nurse understands that correct hand placement is located over the:

Lower third of the sternum

Upper half of the sternum

Upper third of the sternum

Lower half of the sternum

During cardiopulmonary resuscitation (CPR), the nurse should place their hands on the lower half of the sternum when performing chest compressions. This is the correct hand placement because it allows for effective compression of the heart, which is located behind the sternum. By compressing the lower half of the sternum, the nurse can effectively pump blood to the vital organs and maintain circulation during CPR.

Explanation

During cardiopulmonary resuscitation (CPR), the nurse should place their hands on the lower half of the sternum when performing chest compressions. This is the correct hand placement because it allows for effective compression of the heart, which is located behind the sternum. By compressing the lower half of the sternum, the nurse can effectively pump blood to the vital organs and maintain circulation during CPR.

10. A nursing instructor asks aa nursing student to describe the procedure for performing the Heimlich maneuver on an unconscious pregnant womanat 8 months gestation. The student describes the procedure correctly if the student states that which of the followig should be done:

Perform abdominal thrusts until the object is dislodged

Place the hands in the pelvis to perorm the thrusts

Place a rolled blanket under the right abdominal flank and hip area

Perform left lateral abdominal thrusts until the object is dislodged

The correct answer is to place a rolled blanket under the right abdominal flank and hip area. This is because when performing the Heimlich maneuver on an unconscious pregnant woman at 8 months gestation, it is important to avoid direct pressure on the abdomen to prevent harm to the fetus. Placing a rolled blanket under the right abdominal flank and hip area helps to dislodge the object without applying direct pressure on the abdomen.

Explanation

The correct answer is to place a rolled blanket under the right abdominal flank and hip area. This is because when performing the Heimlich maneuver on an unconscious pregnant woman at 8 months gestation, it is important to avoid direct pressure on the abdomen to prevent harm to the fetus. Placing a rolled blanket under the right abdominal flank and hip area helps to dislodge the object without applying direct pressure on the abdomen.

Nursing NCLEX Practice

1. A nurse is teaching cardiopulmonary resusitation to a group of community members. The nurse asks a member fo the group to describe the reswon why blind finger sweeps are avoided in infants. The nurse determines that the person understands this reason if the person makes which statement:

2.

What first name or nickname would you like us to use?

2. A nurse is preparing to attempt to relieve an airway obstruction in a 3 year old conscious child. The nurse performs this maneuver by palcing the hands between the:

3. A nurse witnesses a neighbor's husband sustain a fall from the roof of his house. The nurse rushes to the victim and determines the need to open the airway. The nurse opens the aireay in this victim by using whci appropriate method?

4. A nurse is performing cardiopulmonar resuscitation on an infant. When performing chest compressions, the nurse understands that the compression rate is at least:

6. A nurse is performing CPR on an adult client. The nurse understands that, when chest compressions are performed, the sternum should be depressed:

7. A nurse on the day shift walks into a clients room and finds the client unresponsive. The client is not breathing and does not have a pulse, and the nurse immediately calls out for help. The next nursing action is which of the following:

8. A nurse is performing basic life support(BLS) on a 6 year old child. The nurse delivers how many breaths per minute to the child:

9. A nurse is performing cardiopulmonary resuscitation(CPR) on an adult client. When performing chest compressins, the nurse understands that correct hand placement is located over the:

10. A nursing instructor asks aa nursing student to describe the procedure for performing the Heimlich maneuver on an unconscious pregnant womanat 8 months gestation. The student describes the procedure correctly if the student states that which of the followig should be done: