ATI RN
Nursing Process Questions and Answers PDF Questions
Question 1 of 5
A client who suffered a vehicular accident a few days ago is in skeletal traction. Which nursing action would BESt promote INDEPENDENCE for this patient?
Correct Answer: B
Rationale: The correct answer is B because encouraging the patient to do leg exercises within the limits of his traction promotes independence by maintaining muscle strength and mobility. This helps prevent muscle atrophy and promotes circulation. Choice A focuses on pain management but does not directly promote independence. Choice C provides assistance but does not actively involve the patient in self-care. Choice D is important for overall care but does not directly promote independence through active patient involvement.
Question 2 of 5
Mrs. Go is suspected of experiencing respiratory distress from a left-sided pneumothorax. She should be positioned:
Correct Answer: A
Rationale: The correct answer is A: in a semi-fowler's position. This position helps to improve ventilation and oxygenation by allowing the unaffected lung to expand fully. It also prevents further compression of the affected lung. Trendelenburg position (B) could worsen the pneumothorax by causing more pressure on the affected lung. Prone position (C) is not recommended as it can further compress the affected lung. Placing the patient on the right side (D) would not be beneficial in this case as it does not facilitate lung expansion on the affected side.
Question 3 of 5
. A client is diagnosed with the syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result?
Correct Answer: A
Rationale: The correct answer is A: Decreased serum sodium level. In SIADH, there is an excessive release of ADH, causing water retention and dilution of sodium in the blood. This leads to hyponatremia. B: Increased blood urea nitrogen and C: Decreased serum creatinine level are not typically associated with SIADH. D: Increased hematocrit is not a typical finding in SIADH, as it is more related to dehydration. Therefore, the most anticipated laboratory test result in a client with SIADH is a decreased serum sodium level due to dilutional hyponatremia.
Question 4 of 5
. A client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are only effective if the client:
Correct Answer: B
Rationale: Rationale: 1. Oral antidiabetic agents target insulin resistance, common in type 2 diabetes. 2. Type 1 diabetes lacks insulin production, making oral agents ineffective. 3. Choice A is incorrect as insulin cannot be taken orally. 4. Choice C is incorrect as oral agents are not indicated for type 2 diabetes. 5. Choice D is incorrect as pregnancy does not affect the type of diabetes.
Question 5 of 5
An agitated, confused client arrives in the emergency department. The client’s history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:
Correct Answer: C
Rationale: The correct answer is C: 10 to 15 g of a simple carbohydrate. This amount of carbohydrate is recommended for treating hypoglycemia in clients with diabetes to quickly raise blood glucose levels without causing hyperglycemia. Consuming too little carbohydrate may not effectively raise blood glucose levels, while consuming too much may lead to a rapid spike followed by a rebound hypoglycemia. Options A and B provide insufficient amounts of carbohydrate, while option D provides excessive carbohydrate, increasing the risk of hyperglycemia. Therefore, option C is the most appropriate choice for effectively treating hypoglycemia in this client.