NCLEX-RN
ATI NCLEX-RN Practice Questions Questions
Extract:
Question 1 of 5
A client with cancer received platelet infusions 24 hours ago.
Correct Answer: D
Rationale: Platelet infusions aim to improve clotting. Decreased oozing from an IV site (
D) indicates effective platelet function. Hemoglobin (
A), temperature (
B), and WBC (
C) are not directly affected.
Question 2 of 5
The nurse is caring for a client with myasthenia gravis who is having trouble breathing. The nurse would encourage which of the following positions for maximal lung expansion?
Correct Answer: D
Rationale: Sitting or high Fowler’s position maximizes lung expansion by reducing diaphragm pressure in myasthenia gravis. Supine (
A), side-lying (
B), and prone (
C) positions restrict breathing.
Question 3 of 5
A 6-month-old infant who was diagnosed at 4 weeks of age with a ventricular septal defect, was admitted today with a diagnosis of failure to thrive. His mother stated that he had not been eating well for the past month. A cardiac catheterization reveals congestive heart failure. All of the following nursing diagnoses are appropriate. Which nursing diagnosis should have priority?
Correct Answer: D
Rationale: Altered nutrition occurs owing to the fatigue from decreased cardiac output associated with congestive heart failure. The decreased intake occurs due to fatigue from the altered cardiac output. Fatigue occurs due to the decreased cardiac output. The ineffective action of the myocardium leads to inadequate O2 to the tissues, which produces activity intolerance, altered nutrition, and altered growth and development.
Question 4 of 5
Which of the following signs and symptoms indicates a tension pneumothorax as compared to an open pneumothorax?
Correct Answer: C
Rationale: The tension pneumothorax acts like a one-way valve so that the pneumothorax increases with each breath. Eventually, it occupies enough space to shift mediastinal tissue toward the unaffected side away from the midline. Tracheal deviation, movement of point of maximum impulse, and decreased cardiac output will occur. The other three options will occur in both types of pneumothorax.
Question 5 of 5
The nurse is caring for a client with a radium implant for the treatment of cervical cancer. While caring for the client with a radioactive implant, the nurse should:
Correct Answer: D
Rationale: Wearing a radiation badge monitors exposure during care of a client with a radium implant, ensuring safety. Prolonged time, standing at the bed's foot, or avoiding items is less practical.