NCLEX-RN
ATI NCLEX-RN Practice Questions Questions
Extract:
Question 1 of 5
The nurse is caring for a client with a history of a diabetic foot ulcer. The nurse should:
Correct Answer: B
Rationale: Elevating the foot reduces swelling and promotes healing in a diabetic foot ulcer. Heating pads, soaking, and massage increase infection risk or impair circulation.
Question 2 of 5
A 5-year-old has just had a tonsillectomy and adenoidectomy. Which of these nursing measures should be included in the postoperative care?
Correct Answer: D
Rationale: The nurse should discourage the child from coughing, clearing the throat, or putting objects in his mouth. These may induce bleeding. Cool, clear liquids may be given when child is fully alert. Warm liquids may dislodge a blood clot. The nurse should avoid red- or brown-colored liquids to distinguish fresh or old blood from ingested liquid should the child vomit. Gargles and vigorous toothbrushing could initiate bleeding. Postoperative hemorrhage, though unusual, may occur. The nurse should observe for bleeding by looking directly into the throat and for vomiting of bright red blood, continuous swallowing, and changes in vital signs.
Question 3 of 5
A client is scheduled for a magnetic resonance imaging (MRI) to locate a cerebral lesion. It is important for the nurse to find out if he has a(n):
Correct Answer: C
Rationale: Iodine is not used as a contrast medium for MRI. It is important to inquire about allergy to seafood if the client is to have an arteriogram or enhanced computer tomography. MRI is safe if seizures are under control. It is more important to inquire about movable metal implants. Clients with movable metal implants such as shrapnel or aneurysm clips or clients with permanent pacemakers or implanted pumps can be traumatized during an MRI. Nonmovable metal prostheses or hardware will not cause trauma during an MRI.
Question 4 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 5 of 5
A psychotic client who believes that he is God and rules all the universe is experiencing which type of delusion?
Correct Answer: B
Rationale: These delusions are related to the belief that an individual has an incurable illness. These delusions are related to feelings of self-importance and uniqueness. These delusions are related to feelings of being conspired against. These delusions are related to denial of self-existence.