ATI LPN
NCLEX Questions Patient Centered Care Questions
Question 1 of 5
A patient admitted with a diagnosis of Alzheimer's disease is anxious and dehydrated,has reportedly not been eating and has had a weight loss of $5 \mathrm{lb}$ in 1 week. Which nursing diagnosis is a priority?
Correct Answer: A
Rationale: Dehydration (A) is the priority due to immediate physiological risk (e.g., organ failure) over nutrition (B), which is secondary. C is incorrect (no excessive fluid), and D (skin integrity) is less urgent than fluid replacement in Alzheimer’s-related dehydration, making A the priority.
Question 2 of 5
The nurse is admitting a 64-year-old Hispanic male patient to the rehabilitation facility following surgical intervention for a broken hip. The nurse should first assess which of the following?
Correct Answer: D
Rationale: Pain (D) is the priority post-surgery, impacting recovery and rehab. A, B, and C are assessed later, making D the initial focus, using pain scales or graphics if language barriers exist.
Question 3 of 5
A nursing intervention directs the patient to be turned every 2 hours to prevent skin breakdown from immobility. Assessment findings on new reddened areas on the lateral aspects of the right knee and ankle are obtained. What is the most appropriate way for these findings to be used when the care plan is evaluated?
Correct Answer: D
Rationale: Evaluation adjusts the plan based on outcomes (D); redness after 2-hour turns indicates a need for hourly turns to prevent breakdown. A (documentation) doesn’t adjust care, B is incorrect (problem is actual), and C (calling MD) isn’t independent, making D the best response.
Question 4 of 5
A nurse is caring for a client who has urinary leakage due to nerve damage following a spinal cord injury. The nurse should identify that the client is experiencing which of the following types of urinary incontinence?
Correct Answer: A
Rationale: Reflex incontinence occurs due to involuntary bladder contractions from nerve damage, such as after a spinal cord injury, causing the bladder to empty without the client's control. Stress incontinence (B) involves leakage from physical pressure, urge incontinence (C) involves a sudden need to urinate, and overflow incontinence (D) results from incomplete emptying, none of which align with nerve damage-related involuntary emptying.
Question 5 of 5
The Joint Commission focuses on safety in health care. Which action by the nurse reflects The Joint Commission's main objective?
Correct Answer: C
Rationale: Assessing respirations when administering opioids directly addresses safety by preventing respiratory depression, aligning with The Joint Commission’s focus. Range-of-motion exercises (A), meal intake (B), and delegation (D) are valuable but not primarily safety-focused.