NCLEX-RN
ATI NCLEX-RN Practice Questions Questions
Extract:
Question 1 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 2 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.
Question 3 of 5
The nurse is caring for a client following a laryngectomy. The nurse can best help the client with communication by:
Correct Answer: A
Rationale: A pad and pencil allow immediate, effective communication for a client post-laryngectomy, who cannot speak due to removal of the voice box.
Question 4 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 5 of 5
The nurse is caring for a client with a history of a seizure disorder who is receiving Lamotrigine (Lamictal). The nurse should monitor the client for:
Correct Answer: A
Rationale: Lamotrigine can cause a serious rash, including Stevens-Johnson syndrome, requiring immediate monitoring and reporting. Hypotension, hyperglycemia, and weight gain are not primary concerns.