NCLEX-RN
ATI NCLEX-RN Practice Questions Questions
Extract:
Question 1 of 5
A client is diagnosed with organic brain disorder. The nursing care should include:
Correct Answer: A
Rationale: An organized, safe environment minimizes confusion and ensures safety for clients with organic brain disorders.
Question 2 of 5
A 28-year-old client performs a long, involved ritual in getting up and preparing for the day. He became unable to get to his job before noon. His family, in desperation, has admitted him to the hospital's psychiatric unit. On the unit, he is always late for breakfast, which is served at 8 am. The nurse identifies that the best approach to this problem is to:
Correct Answer: C
Rationale:
To interfere with the ritual will increase anxiety. Arranging the schedule to allow completion of the ritual before essential activities like breakfast accommodates the client's needs while addressing the issue.
Question 3 of 5
A client with a history of a liver transplant is receiving Tacrolimus (Prograf). The nurse should monitor the client for:
Correct Answer: A
Rationale: Tacrolimus is nephrotoxic, requiring monitoring of renal function (e.g., creatinine). Hyperglycemia is possible but less critical, and hypotension/hair loss are not primary concerns.
Question 4 of 5
Medication is administered to a client who has been placed in restraints after a sudden violent episode, and his EPSs subside. Restraints can be removed when:
Correct Answer: B
Rationale: While the client is still restrained, but after violent behavior has subsided, a therapeutic bridge is built. This alliance encourages dialogue between nurse and client, allowing the client to determine causative factors, feelings prior to loss of control, and adaptive alternatives to violence.
Question 5 of 5
A client is admitted to the unit two hours after an explosion causes burns to the face. The nurse would be most concerned with the client developing which of the following?
Correct Answer: B
Rationale: Facial burns can cause swelling and laryngeal edema compromising the airway within hours. This is the most immediate life-threatening concern. Hypovolemia hypernatremia and hyperkalemia are also risks but are less urgent in the first two hours.