ATI RN
ADPIE Nursing Process Questions Questions
Question 1 of 5
A nurse is preparing to carry out interventions. Which resources will the nurse make sure are available? (Select all that apply.)
Correct Answer: A
Rationale: The correct answer is A: Equipment. The nurse needs to ensure that necessary equipment is available to carry out interventions effectively and safely. Without the right equipment, the nurse may not be able to provide appropriate care. Safe environment (B) is important but not a resource that the nurse makes sure is available. Confidence (C) is a personal attribute and not a resource. Assistive personnel (D) are individuals who can help but are not resources that the nurse ensures are available.
Question 2 of 5
Which of the ff nursing interventions is involved when caring for a client with influenza?
Correct Answer: C
Rationale: The correct answer is C: Immediate recognition of respiratory distress. This is crucial when caring for a client with influenza as the virus can lead to respiratory complications. Prompt recognition allows for timely intervention and prevents further deterioration. A: Maintaining airborne transmission is incorrect as the goal is to prevent the spread of influenza through droplet precautions, not airborne transmission. B: Oxygen administration may be necessary for severe cases of influenza, but immediate recognition of respiratory distress takes precedence in the nursing interventions. D: Complete bed rest is not recommended for influenza as mobilization and deep breathing exercises are important to prevent complications like pneumonia.
Question 3 of 5
During chemotherapy for lymphocytic leukemia, a client develops abdominal pain, fever, and “horse barn” smelling diarrhea. It would be most important for the nurse to advise the physician to order:
Correct Answer: B
Rationale: The correct answer is B: Stool for Clostridium difficile test. In this scenario, the client is experiencing symptoms suggestive of a possible Clostridium difficile infection, a common complication of chemotherapy. The test is crucial to confirm the presence of C. difficile toxins in the stool, which would guide appropriate treatment with antibiotics such as metronidazole or vancomycin. A: Enzyme-linked immunosuppressant assay is not relevant in this context as it is used to measure levels of immunosuppressant drugs, not for diagnosing C. difficile infection. C: Flat palate X-ray of the abdomen is unnecessary and would not provide information about the cause of the symptoms. D: Electrolyte panel and hemogram are important for monitoring overall health status but do not directly address the specific issue of possible C. difficile infection.
Question 4 of 5
The client with trigeminal neuralgia tells the nurse that acetaminophen (Tylenol) is taken daily for the relief of generalized discomfort. Which laboratory value would indicate toxicity associated with the medication?
Correct Answer: B
Rationale: The correct answer is B: Direct bilirubin level of 2 mg/dl. Acetaminophen toxicity can lead to liver damage, causing an increase in bilirubin levels. Direct bilirubin specifically indicates liver function. A: Sodium level is not related to acetaminophen toxicity. C: Prothrombin time is a measure of blood clotting, not indicative of acetaminophen toxicity. D: Platelet count is not affected by acetaminophen toxicity.
Question 5 of 5
As part of primary cancer prevention program, an oncology nurse answers questions from the public at health fair. When someone asks about the laryngeal cancer, the nurse should explain that:
Correct Answer: A
Rationale: The correct answer is A: Laryngeal cancer is one of the most preventable types of cancer. This is because the primary risk factors for laryngeal cancer are largely related to lifestyle choices such as smoking, excessive alcohol consumption, and exposure to certain occupational hazards. By avoiding these risk factors, individuals can significantly reduce their chances of developing laryngeal cancer. Choices B, C, and D are incorrect: B: Inhaling polluted air isn’t a risk factor for laryngeal cancer - This is incorrect as exposure to polluted air can contribute to the development of laryngeal cancer. C: Laryngeal cancer occurs primarily in women - This is incorrect as laryngeal cancer occurs more frequently in men than in women. D: Adenocarcinoma accounts for most cases of laryngeal cancer - This is incorrect as squamous cell carcinoma is the most common type of laryngeal cancer, not adenocarcin
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