NCLEX-RN
ATI NCLEX-RN Practice Questions Questions
Extract:
Question 1 of 5
A client with severe anemia is to receive a unit of packed red blood cells. In the event of a transfusion reaction, the first action by the nurse should be to:
Correct Answer: B
Rationale: Stopping the transfusion and maintaining an IV of normal saline is the first action to prevent further reaction and stabilize the client.
Question 2 of 5
A client with metastatic cancer of the lung has just been told the prognosis by the oncologist. The nurse hears the client state, "I don't believe the doctor; I think he has me confused with another patient."
Correct Answer: A
Rationale: The client's statement reflects denial, the first stage of Kubler-Ross' model, where patients refuse to accept a terminal prognosis. Anger (
B), depression (
C), and bargaining (
D) involve different emotional responses.
Question 3 of 5
The nurse is caring for a client with a history of ankylosing spondylitis. The nurse should expect the client to have:
Correct Answer: A
Rationale: Ankylosing spondylitis causes chronic inflammation of the spine, leading to spinal stiffness, especially in the morning.
Question 4 of 5
The nurse has just received the change of shift report. Which client should the nurse assess first?
Correct Answer: A
Rationale: The client two hours post-lobectomy with 150mL of chest drainage is at risk for complications such as hemorrhage or tension pneumothorax, requiring immediate assessment. The other clients are stable: scant drainage is expected post-gastrectomy, a fever in pneumonia is concerning but less urgent, and a fractured hip in traction is typically stable.
Question 5 of 5
A male client receives 10 U of regular human insulin SC at 9:00 AM. The nurse would expect peak action from this injection to occur at:
Correct Answer: C
Rationale: Regular insulin peaks 2-4 hours after administration, so 12 noon is the expected peak time for a 9:00 AM dose.