ATI RN
Pharmacology and the Nursing Process 10th Edition Test Bank Questions
Question 1 of 9
A client is diagnosed with human immunodeficiency virus (HIV). After recovering from the initial shock of the diagnosis, the client expresses a desire to learn as much as possible about HIV and acquired immunodeficiency syndrome (AIDS). When teaching the client about the immune system, the nurse states that adaptive immunity is provide by which type of white blood cell?
Correct Answer: D
Rationale: The correct answer is D: Lymphocyte. Lymphocytes are a type of white blood cell that play a crucial role in adaptive immunity. They include T cells and B cells, which are responsible for recognizing and attacking specific pathogens. T cells help regulate the immune response and directly attack infected cells, while B cells produce antibodies to target pathogens. Neutrophils (A), monocytes (B), and basophils (C) are important for innate immunity, not adaptive immunity. Neutrophils are phagocytic cells that engulf and destroy pathogens, monocytes differentiate into macrophages to engulf pathogens, and basophils are involved in allergic reactions. Therefore, the correct answer is D because lymphocytes are key players in adaptive immunity.
Question 2 of 9
A client with Addison’s disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of:
Correct Answer: D
Rationale: The correct answer is D. In Addison's disease, the adrenal glands do not produce enough cortisol and aldosterone. This leads to sodium and potassium imbalances. Low aldosterone causes sodium loss and potassium retention, resulting in sodium and potassium abnormalities. The other choices, A, B, and C, do not directly relate to Addison's disease. Calcium and phosphorus abnormalities are not typically associated with Addison's disease. Sodium and chloride, and chloride and magnesium imbalances are not primary concerns in Addison's disease. Therefore, staying alert for signs and symptoms of sodium and potassium abnormalities is crucial in managing and monitoring a client with Addison's disease.
Question 3 of 9
A patient was diagnosed with hiatal hernia. She frequently has regurgitation and a sour taste on his mouth especially after eating large meals. Which action by the client shows understanding of her treatment regimen?
Correct Answer: D
Rationale: The correct answer is D: avoid caffeine, alcohol, and chocolate. This helps to reduce acid reflux symptoms associated with hiatal hernia. Caffeine, alcohol, and chocolate can relax the lower esophageal sphincter, leading to increased reflux. Elevating legs (choice A) does not address the underlying issue. Drinking more fluids (choice B) can exacerbate symptoms by increasing stomach volume. Increasing roughage (choice C) may worsen symptoms due to increased gastric distension. By avoiding triggers like caffeine, alcohol, and chocolate, the client can effectively manage her symptoms.
Question 4 of 9
In which of the ff clients will an MRI scan be contraindicated?
Correct Answer: B
Rationale: The correct answer is B: Clients with metal implants in their body. An MRI uses strong magnetic fields, which can interact with metal implants, causing movement or heating of the metal and potential harm to the client. This could lead to serious injuries or complications during the scan. Overweight clients (choice A), clients over the age of 60 (choice C), and clients with brain tumors (choice D) do not have contraindications for an MRI scan.
Question 5 of 9
The nurse establishes trust and talks with a school-aged patient before administering an injection. Which type of implementation skill is the nurse using?
Correct Answer: B
Rationale: The correct answer is B: Interpersonal. The nurse is using interpersonal skills by establishing trust and communicating with the patient before administering the injection. This helps build rapport and alleviate anxiety. Cognitive skills involve problem-solving and critical thinking, not direct patient interaction. Psychomotor skills relate to physical tasks like giving injections. Judgmental skills involve making decisions based on critical thinking, not directly related to patient communication.
Question 6 of 9
Which of the following nursing interventions will help prevent a further increase in ICP?
Correct Answer: C
Rationale: Elevating the head of the bed is the correct answer because it helps to promote venous drainage, reduce cerebral edema, and decrease intracranial pressure (ICP). By positioning the patient with the head elevated, gravity assists in preventing further increases in ICP. Encouraging fluids may lead to fluid overload and exacerbate cerebral edema. Providing physical therapy and frequent repositioning may increase ICP by causing unnecessary movement and potential strain on the patient's head and neck.
Question 7 of 9
Serum albumin Is to be administered intravenously to client with ascites, The expected outcome of this treatment will be a decrease in:
Correct Answer: C
Rationale: The correct answer is C: Abdominal girth. Serum albumin helps to increase oncotic pressure in the blood vessels, reducing fluid leakage into the abdomen and decreasing ascites, leading to a decrease in abdominal girth. Option A is incorrect because serum albumin does not directly affect urinary output. Option B is incorrect as serum albumin does not directly impact serum ammonia levels. Option D is incorrect because while serum albumin can help improve liver function, it does not directly treat hepatic encephalopathy.
Question 8 of 9
A patient returns from surgery ff. a TURP with a three-way Foley catheter and continuous bladder irrigation. Postoperative orders include Meperidine (Demerol) 75 mg IM q3h as needed for pain, belladonna and opium (B&O) suppository q4h as needed, and strict I&O. the patient complains of painful bladder spasms, and the nurse observes blood-tinged urine on the sheets. Which action should the nurse take?
Correct Answer: D
Rationale: The correct action for the nurse to take is to notify the physician stat (choice D). Firstly, the patient presents with painful bladder spasms and blood-tinged urine, indicating a potential complication post-TURP. This warrants immediate medical attention to assess for possible bladder injury or hemorrhage. Giving Demerol (choice A) or B&O suppository (choice B) may provide symptomatic relief but does not address the underlying issue. Warming the irrigation solution (choice C) is not a priority in this situation and does not address the potential serious complications. Notifying the physician immediately allows for prompt evaluation and appropriate intervention to address the patient's condition effectively.
Question 9 of 9
In which of the ff circumstances should a nurse avoid using midline and mid clavicular sites for IV therapy? Choose all that apply.
Correct Answer: B
Rationale: The correct answer is B: To administer antineoplastic chemotherapy. This is because antineoplastic chemotherapy agents are highly irritating and toxic to the surrounding tissues. Using midline and mid clavicular sites for IV therapy in this case can increase the risk of extravasation, leading to tissue damage and potential complications. Incorrect choices: A: To administer solutions with a pH greater than 5 and less than 9 - pH of the solution does not directly affect the choice of site for IV therapy. C: To administer slow, low-volume infusions - Midline and mid clavicular sites can be appropriate for slow, low-volume infusions. D: To administer high-pressure bolus injections - While midline and mid clavicular sites may not be ideal for high-pressure bolus injections, the question specifically mentions IV therapy, not bolus injections.