NCLEX-RN
ATI NCLEX-RN Practice Questions Questions
Extract:
Question 1 of 5
A female client at 36 weeks' gestation has been treated successfully for premature labor for 4 weeks. She has begun having uterine contractions today and has been admitted to the labor and delivery suite. Her amniocentesis results reveal a lecithin/sphingomyelin (L/S) ratio of 2 and positive phosphatidylglycerol (PG). These lab values indicate:
Correct Answer: D
Rationale: Placental maturity is assessed by a biophysical profile. L/S ratio and presence of phosphatidylglycerol are not used to determine fetal asphyxia. A biophysical profile score of 6 may indicate this condition. Cord compression is not reflected by the L/S ratio or presence of phosphatidylglycerol. Variable decelerations observed through electronic fetal monitoring could reflect umbilical cord compression. An L/S ratio >2 and the presence of phosphatidylglycerol in amniotic fluid indicate fetal lung maturity.
Question 2 of 5
A client with a history of a burn injury is being discharged. The nurse should teach the client to:
Correct Answer: B
Rationale: Loose clothing prevents irritation and promotes healing in burn injuries. Petroleum lotions, harsh soaps, and air exposure can delay healing or cause infection.
Question 3 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 4 of 5
The initial focus when providing nursing care for a child with rheumatic fever during the acute phase of the illness should be to:
Correct Answer: B
Rationale: This goal is helpful, but rest is essential during the acute phase. Rest is essential for healing to occur and for pain to be relieved. This goal is important, but rest is essential. This goal should be part of the plan of care, but it is not the priority during the acute phase.
Question 5 of 5
At 30 weeks' gestation, a client is admitted to the unit in premature labor. Her physician orders that an IV be started with 500 mL D5W mixed with 150 mg of ritodrine stat. The RN prepares the IV solution with the medication. The RN knows that clients receiving the medication ritodrine IV should be observed closely for which one of the following side effects:
Correct Answer: C
Rationale: Ritodrine is a sympathomimetic β2-adrenergic agonist that can cause vasodilation, leading to hypotension. The body compensates by increasing heart rate, resulting in tachycardia.