Questions 9

ATI RN

ATI RN Test Bank

Fundamentals of Nursing Nursing Process Questions Questions

Question 1 of 5

A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which “related-to” phrase should the nurse add?

Correct Answer: A

Rationale: The correct answer is A: Related to bone demineralization resulting in pathologic fractures. In chronic hyperparathyroidism, there is excessive release of parathyroid hormone, leading to increased bone resorption and calcium release from bones, causing bone demineralization and weakening. This puts the client at risk for pathologic fractures. Choice B is incorrect because exhaustion is not a direct consequence of chronic hyperparathyroidism. Choice C is incorrect as edema and dry skin are not typical manifestations of hyperparathyroidism. Choice D is incorrect because tetany is more commonly associated with hypocalcemia, which is not a typical finding in hyperparathyroidism.

Question 2 of 5

The following statements are on a patient’s nursing care plan. Which statement will the nurse use as an outcome for a goal of care? The patient will verbalize a decreased pain level less than 3 on a 0 to 10 scale by the

Correct Answer: A

Rationale: The correct answer is A because it is specific, measurable, achievable, relevant, and time-bound (SMART) - the patient verbalizing a decreased pain level less than 3 on a 0 to 10 scale by the end of this shift. This outcome is immediate, concrete, and directly related to the goal of managing pain. Choice B is incorrect as it lacks specificity and a clear timeframe for evaluation. Choice C is incorrect because the outcome is vague and does not specify when the patient needs to understand the dietary changes. Choice D is incorrect because the timeframe is provided but the outcome is not specific enough and does not directly relate to the goal of pain management.

Question 3 of 5

A client with uterine cancer asks the nurse, “Which is the most common type of cancer in women?” The nurse replies that it’s breast cancer. Which type of cancer causes the most deaths in women?

Correct Answer: B

Rationale: The correct answer is B: Lung cancer. Lung cancer causes the most deaths in women due to its high mortality rate. It is often diagnosed at an advanced stage, leading to poorer outcomes. Breast cancer, although common, has a lower mortality rate compared to lung cancer. Brain cancer is relatively rare in comparison. Colon and rectal cancer, while significant, do not surpass lung cancer in terms of causing the most deaths in women.

Question 4 of 5

During thoracentesis, which of the following nursing intervention will be most crucial?

Correct Answer: B

Rationale: The correct answer is B: Maintain strict aseptic technique. This is crucial during thoracentesis to prevent infection. Step 1: Before the procedure, sterile equipment and supplies must be used. Step 2: Proper hand hygiene is essential to reduce the risk of introducing pathogens. Step 3: During the procedure, maintaining a sterile field helps minimize the risk of contamination. Step 4: After the procedure, ensuring proper disposal of all used supplies prevents the spread of infection. Summary: A: Placing the patient in a quiet and cool room may be comforting but is not directly related to the safety of the procedure. C: Advising the patient to sit still is important for accurate needle insertion but does not address infection prevention. D: Applying pressure over the puncture site is important but does not prevent infection if aseptic technique is not maintained.

Question 5 of 5

A nurse is using assessment data gathered about a patient and combining critical thinking to develop a nursing diagnosis. What is the nurse doing?

Correct Answer: C

Rationale: The correct answer is C: Diagnostic reasoning. The nurse is utilizing assessment data to analyze and interpret the information to develop a nursing diagnosis. This involves critical thinking skills to make conclusions and create a plan of care. A: Assigning clinical cues - This choice is incorrect as it refers to identifying objective and subjective data during assessment, not the process of analyzing and synthesizing data to form a diagnosis. B: Defining characteristics - This choice is incorrect as it typically refers to the specific manifestations or symptoms associated with a particular nursing diagnosis, not the process of diagnosing itself. D: Diagnostic labeling - This choice is incorrect as it refers to the final step in the nursing diagnosis process where the nurse assigns a label to the identified problem, not the overall process of diagnostic reasoning.

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