ATI RN
Critical Care Nursing NCLEX Questions Questions
Question 1 of 5
The nurse is assessing a client who complains of weight loss, racing heart rate, and difficulty sleeping. The nurse determines the client has moist skin with fine hair, prominent eyes, lid retraction, and a staring expression. These findings are consistent with which disorder?
Correct Answer: A
Rationale:
Step 1: Symptoms of weight loss, racing heart rate, and difficulty sleeping are common in hyperthyroidism.
Step 2: Presence of moist skin, fine hair, prominent eyes, lid retraction, and staring expression are classic signs of Grave's disease, a type of hyperthyroidism.
Step 3: Grave's disease is an autoimmune disorder where the thyroid gland is overactive, leading to excessive production of thyroid hormones.
Step 4: Excess thyroid hormones increase metabolic rate, causing weight loss, racing heart rate, and insomnia.
Step 5:
Therefore, the findings described in the question are consistent with Grave's disease.
Question 2 of 5
The son of a dying patient tells the nurse, 'Mother doesn’t respond anymore when I visit. I don’t think she knows that I am here.' Which response by the nurse is appropriate?
Correct Answer: B
Rationale: The correct answer is B because withdrawal is a common psychological response in the dying process. The nurse should explain to the son that his mother's lack of response may be her way of preparing to leave life. This response validates the son's concerns while providing reassurance.
Choice A is incorrect because cutting back visits may not address the underlying issue of the mother's withdrawal.
Choice C is incorrect because stimulating the mother may not be beneficial or appropriate in this situation.
Choice D is incorrect because not all patients experience a lack of awareness at the end of life, and assuming so may not be helpful in this context.
Question 3 of 5
Which statement is true regarding the effects of caring for dying patients on nurses?
Correct Answer: D
Rationale: The correct answer, D, is supported by the fact that providing aggressive care to patients when nurses believe it is futile can lead to personal ethical conflicts and burnout. This is because nurses may experience moral distress when their values conflict with the care they are providing. This can result in emotional exhaustion and decreased job satisfaction, ultimately leading to burnout.
Choice A is incorrect because attending funerals can be a way for nurses to process their grief and find closure, rather than creating additional stress.
Choice B is incorrect because caring for dying patients can have emotional impacts on nurses, regardless of their professional approach.
Choice C is incorrect because balancing care needs with personal emotional needs can be challenging and may not always be achievable.
Question 4 of 5
The nurse uses the Situation-Background-Assessment-Recommendation (SBAR) format to communicate a change in patient status to a healthcare provider. In which order should the nurse make the following statements?
Correct Answer: B
Rationale:
Step 1: Start with Background - statement B provides relevant background information about the patient's current condition and why there is a need for communication.
Step 2: Move on to Situation - statement D sets the current situation where the nurse expresses concern about the patient's symptom.
Step 3: Next is Assessment - statement C details the nurse's assessment findings, highlighting the critical aspects of the patient's condition.
Step 4: End with Recommendation - statement A suggests the necessary action to be taken based on the assessment findings. This order ensures a clear and structured communication process.
Summary:
-
Choice A is incorrect as the recommendation should come after providing background, situation, and assessment.
-
Choice C is incorrect as assessment details should precede the patient's critical condition.
-
Choice D is incorrect as the situation should be explained before expressing concern.
Question 5 of 5
A patient in hospice care is experiencing dyspnea. What is the most appropriate nursing intervention?
Correct Answer: B
Rationale: The correct answer is B: Administer oxygen as prescribed. Dyspnea in a hospice patient often indicates respiratory distress, and administering oxygen can help improve oxygenation and alleviate breathing difficulty. Positioning the patient flat on their back (
A) may worsen dyspnea due to increased pressure on the diaphragm. Restricting fluid intake (
C) is not appropriate as dehydration can exacerbate respiratory distress. Chest physiotherapy (
D) may not be suitable for a hospice patient experiencing dyspnea as it can be physically taxing and may not address the underlying cause effectively.