NCLEX-RN
ATI NCLEX-RN Practice Questions Questions
Extract:
Question 1 of 5
A client with a history of endometriosis is admitted with complaints of pelvic pain. The nurse should expect the client to have:
Correct Answer: A
Rationale: Endometriosis causes pelvic pain and dysmenorrhea due to ectopic endometrial tissue responding to hormonal changes.
Question 2 of 5
A 2-year-old child will undergo a cardiac catheterization tomorrow to evaluate his ventricular septal defect. Based on his developmental stage, the nurse:
Correct Answer: B
Rationale: A toddler is not capable of conceptualizing about the inside of his body and is concerned about body intactness; therefore, diagrams would not be useful. Also, the previous evening is too far from the procedure for the toddler to remember the instructions. A simple explanation the morning of the procedure is the best developmental strategy to use, because it focuses on the toddler's need for parental support, body intactness, and short attention span. A relationship between the nurse and the child needs to develop. Also, misinformation may be given to the child if the parents explain the procedure to the child. The parents are the child's support system and need to be there to strengthen the child.
Question 3 of 5
The nurse is caring for a client with scalding burns across the face, neck, upper half of the anterior chest, and entire right arm.
Correct Answer: 32
Rationale: Rule of nines: face (4.5%), neck (4.5%), upper half anterior chest (9%), right arm (9%) = 4.5 + 4.5 + 9 + 9 = 27%. The closest answer is 32% (
C), possibly due to rounding or partial overlap.
Question 4 of 5
The nurse is caring for a client with a suspected hip fracture. Which intervention should be implemented to prevent complications?
Correct Answer: C
Rationale: Immobilizing the hip with a splint prevents further injury and reduces pain in a suspected hip fracture. Heating pads, dependent positioning, and weight-bearing can worsen the injury.
Question 5 of 5
At 12 hours postvaginal delivery, a female client is without complications. Which of the following assessment findings would warrant further nursing interventions?
Correct Answer: B
Rationale: Bradycardia of 50-70 bpm may be considered normal postpartally because the heart compensates for the decreased resistance in the pelvis. The uterus is displaced from the midline by a full bladder. This condition could lead to a boggy uterus and increased risk of postpartal hemorrhage; therefore, the bladder should be kept empty. Re-establishment of normal bowel function is delayed into the first postpartum week. A postpartum woman's oral temperature may go as high as 100.4°F within 24 hours of delivery resulting from muscular exertion, dehydration, and hormonal changes.