NCLEX RN ATI Review
2026 | Comprehensive
Practice Questions,
Answers & Rationales
|Graded A+ | Guaranteed
success|
Updated 2026 Questions and Answers
100% Verified Exam Prep and Comprehensive
Rationales
Included
, Nursing intervention Restraints Implement nonpharmacologic measures such as distraction, frequent observation,
or diversion activities
Prior to application, review manufacturer's instructions for correct application
Notify the provider immediately when restraints are implemented
Remove the restraints and assess client every 2 hr
Assess neurovascular and neurosensory status every 2 hr
Leave the restraint loose enough to prevent injury
Always tie the restraint to the bed frame (using loose knots that are easily
removed)
Reassess the need for continue use
Document
Document Restraints Behaviors making restraint necessary
Alternatives attempted and the client's response
Type and location of restraint and time applied
Frequency and type of assessment
Restraints should NEVER Interfere with treatment
Be used because of short-staffing or staff convenience
Not written as PRN orders
Nursing intervention Seizure precaution Assess seizure history, noting frequency, presence of auras, and sequence of
events
Identify precipitating factors that may exacerbate or lead to seizure
Review medication history.
If routine lab work is required (Dilantin), when was last level drawn
Place rescue equipment at the bedside, including oxygen, oral airway, and suction
equipment
Establish IV or saline lock access for high risk clients
Inspects the client's environment for items that may cause injury in the event of a
seizure.
Remove any unnecessary items from the immediate environment
At the onset seizure, position the client for safety, and remain with client
If sitting or standing, ease client to floor. Protect the client's head. If client is in
bed, raise the side rails and pad for safety
Roll the client to the side with the head flexed slightly forward
Do not put anything in the client's mouth
Loosen restrictive clothing
Accurately document the event, including timing precipitating behaviors or
events, and a description of the event (movements, loss of consciousness, loss of
continence, injuries, mention of aura, postictal state).
Report seizure to the provider
Fire response R-Rescue: protect and evacuate clients in immediate danger
A-Alarm: Activate the alarm and report the fire
C-Contain: Close doors or windows
E-Extinguish: use correct fire extinguisher to exliminate the fire
"RACE"
Type fire extinguisher Class A
Class B
Class C
2026 | Comprehensive
Practice Questions,
Answers & Rationales
|Graded A+ | Guaranteed
success|
Updated 2026 Questions and Answers
100% Verified Exam Prep and Comprehensive
Rationales
Included
, Nursing intervention Restraints Implement nonpharmacologic measures such as distraction, frequent observation,
or diversion activities
Prior to application, review manufacturer's instructions for correct application
Notify the provider immediately when restraints are implemented
Remove the restraints and assess client every 2 hr
Assess neurovascular and neurosensory status every 2 hr
Leave the restraint loose enough to prevent injury
Always tie the restraint to the bed frame (using loose knots that are easily
removed)
Reassess the need for continue use
Document
Document Restraints Behaviors making restraint necessary
Alternatives attempted and the client's response
Type and location of restraint and time applied
Frequency and type of assessment
Restraints should NEVER Interfere with treatment
Be used because of short-staffing or staff convenience
Not written as PRN orders
Nursing intervention Seizure precaution Assess seizure history, noting frequency, presence of auras, and sequence of
events
Identify precipitating factors that may exacerbate or lead to seizure
Review medication history.
If routine lab work is required (Dilantin), when was last level drawn
Place rescue equipment at the bedside, including oxygen, oral airway, and suction
equipment
Establish IV or saline lock access for high risk clients
Inspects the client's environment for items that may cause injury in the event of a
seizure.
Remove any unnecessary items from the immediate environment
At the onset seizure, position the client for safety, and remain with client
If sitting or standing, ease client to floor. Protect the client's head. If client is in
bed, raise the side rails and pad for safety
Roll the client to the side with the head flexed slightly forward
Do not put anything in the client's mouth
Loosen restrictive clothing
Accurately document the event, including timing precipitating behaviors or
events, and a description of the event (movements, loss of consciousness, loss of
continence, injuries, mention of aura, postictal state).
Report seizure to the provider
Fire response R-Rescue: protect and evacuate clients in immediate danger
A-Alarm: Activate the alarm and report the fire
C-Contain: Close doors or windows
E-Extinguish: use correct fire extinguisher to exliminate the fire
"RACE"
Type fire extinguisher Class A
Class B
Class C
