ATI LPN
Fundamentals of Nursing Vital Signs NCLEX Questions Questions
Question 1 of 5
During the initial admission process, a geriatric client seems confused. What is the most probable cause of this client’s confusion?
Correct Answer: D
Rationale: Stress from an unfamiliar hospital setting (D) commonly causes confusion in geriatric clients. Depression (A) affects mood, memory (B) is usually intact, and LOC (C) isn’t typically age-related.
Question 2 of 5
A client with cirrhosis develops ascites. Which nursing intervention is most appropriate to promote comfort?
Correct Answer: A
Rationale: A diuretic (A) reduces ascites fluid, improving comfort in cirrhosis. Supine position (B) worsens breathing, fluid restriction (C) is inappropriate, and heat (D) risks burns.
Question 3 of 5
With which client health problem does the nurse try to prevent harm by remaining alert for the potential of reduced clotting?
Correct Answer: C
Rationale: Cirrhosis impairs liver function reducing clotting factor production and increasing bleeding risk. Atrial fibrillation (A) increases clotting risk not bleeding. Bone fracture (B) and elevated glucose (D) do not directly affect clotting.
Question 4 of 5
Which nursing assessment finding for a client with fluid volume excess supports the continued presence of this condition?
Correct Answer: B
Rationale: Increased blood pressure (B) indicates fluid volume excess. Weak pulses (A) and poor turgor (D) suggest dehydration. Decreased heart rate (C) is unrelated.
Question 5 of 5
A grandmother taking care of a newborn whose mother has just passed away of AIDS decides to breast feed the baby
Correct Answer: B
Rationale: Wet nursing refers to breastfeeding by someone other than the mother typically when the mother is unavailable. Foster care (A) is legal guardianship dry nursing (C) is not a recognized term and tender loving care (D) is not specific to breastfeeding.