ATI RN
Nursing Process Practice Questions Quizlet Questions
Question 1 of 9
A patient is being given penicillin via IV piggyback and develops an anaphylactic reaction. Which of the following should be the nurse’s first action?
Correct Answer: D
Rationale: The correct answer is D: Turn off the antibiotic. This should be the nurse's first action because in an anaphylactic reaction, stopping the administration of the causative agent is crucial to prevent further harm. Continuing the antibiotic (Choice B) can worsen the reaction. Calling the doctor (Choice A) may cause a delay in the immediate intervention needed. Calling for help (Choice C) is important but turning off the antibiotic takes precedence to stop the allergen.
Question 2 of 9
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: Step-by-step rationale for why choice A is correct: 1. Laryngeal cancer is strongly linked to smoking and alcohol consumption. 2. Both smoking and alcohol use are modifiable risk factors, meaning they can be prevented. 3. By avoiding smoking and excessive alcohol intake, individuals can significantly reduce their risk of developing laryngeal cancer. 4. Therefore, laryngeal cancer is considered one of the most preventable types of cancer. Summary of why the other choices are incorrect: B. Inhaling polluted air can be a risk factor for laryngeal cancer, so this statement is inaccurate. C. Laryngeal cancer occurs more frequently in men than women, so this statement is incorrect. D. Squamous cell carcinoma, not adenocarcinoma, is the most common type of laryngeal cancer, making this statement incorrect.
Question 3 of 9
The nurse is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by:
Correct Answer: C
Rationale: The correct answer is C: Fine needle aspiration. This procedure involves inserting a thin needle into the lump to extract cells for examination. It provides a definitive diagnosis of breast cancer by analyzing the cells for cancerous features. Breast self-examination (A) is a screening tool but cannot confirm a diagnosis. Mammography (B) is used for screening and detecting abnormalities but also requires further testing for diagnosis. Chest x-ray (D) is not used to diagnose breast cancer.
Question 4 of 9
The nurse is attempting to prompt the patient to elaborate on the reports of daytime fatigue. Which question should the nurse ask?
Correct Answer: B
Rationale: The correct answer is B because it encourages the patient to reflect on the potential causes of their fatigue, leading to a more detailed and insightful response. This open-ended question allows the patient to explore various factors contributing to their fatigue, such as lifestyle habits, medical conditions, or emotional stressors. Choice A focuses on stress, which may not be the primary cause of fatigue for the patient. Choice C is too specific and may not uncover other relevant information. Choice D assumes that sleep duration is the sole factor contributing to fatigue, neglecting other possible causes. Overall, choice B facilitates a more comprehensive discussion and helps the nurse gather valuable information to address the patient's concerns effectively.
Question 5 of 9
A client has undergone a nephrectomy and is placed under observation after a urethral catheter insertion. As part of the nursing care plan, the nurse records the color of drainage from each tube and catheter. Which of the ff is the reason for this?
Correct Answer: B
Rationale: The correct answer is B: To provide a means for further comparison and evaluation. By recording the color of drainage from each tube and catheter, the nurse can monitor changes over time, assess for any abnormalities, and evaluate the effectiveness of treatment. This helps in detecting complications early and making informed decisions. Rationale for other choices: A: To restore and maintain intravascular volume - Monitoring drainage color does not directly relate to intravascular volume status. C: To avoid interference with wound drainage - Monitoring drainage color does not prevent interference with wound drainage. D: To prevent pain related to obstruction - Monitoring drainage color does not directly prevent pain related to obstruction.
Question 6 of 9
A newly admitted patient who is morbidly obese asks the nurse for assistance to the bathroom for the first time. Which action should the nurse take initially?
Correct Answer: A
Rationale: Step-by-step rationale for why answer A is correct: 1. Safety: Morbidly obese patients are at higher risk of falls during transfers. 2. Assistance: Having two other personnel ensures safe transfer. 3. Weight distribution: Distributing the patient's weight among multiple helpers reduces strain. 4. Proper body mechanics: Allows for proper positioning and technique while assisting. Summary of why other choices are incorrect: B. Medication doesn't address the safety concern of transferring a morbidly obese patient. C. Reviewing activity orders is not the immediate action needed for the patient's first bathroom transfer. D. Offering a walker may not provide sufficient support for a morbidly obese patient during the transfer.
Question 7 of 9
A nurse identifies Fatigue as a health problem and nursing diagnosis for a client receiving home care for metastatic cancer. What statement or question would be best to validate this client problem?
Correct Answer: D
Rationale: The correct answer is D because it involves collaboration with the client to validate the identified health problem. By asking the client directly if they agree that fatigue is a problem for them, it promotes client-centered care and empowers the client in their own care. Choice A is incorrect as it assumes the nurse's assessment is enough to confirm fatigue. Choice B is incorrect as it focuses on the nurse's analysis rather than the client's experience. Choice C is incorrect because it is a closed-ended question that may not encourage open communication or validation from the client.
Question 8 of 9
A patient is scheduled for an MRI and asks what to expect. Which of the following responses by the nurse is best?
Correct Answer: D
Rationale: The correct answer is D because an MRI is a noninvasive imaging test that uses magnetic energy to produce detailed images of internal body parts. This explanation is accurate and informative, reassuring the patient. A is incorrect because it describes electromyography (EMG), not MRI. B is incorrect as it describes electroencephalography (EEG), not MRI. C is incorrect because it describes a nuclear medicine test, not MRI. In summary, only option D provides a correct and relevant description of what to expect during an MRI.
Question 9 of 9
The nurse teaches a diabetic client that diet plays a crucial role in managing diabetes mellitus. When evaluating dietary intake, the nurse knows the client is eating the right foods if total daily caloric intake consists of:
Correct Answer: C
Rationale: The correct answer is C (50% to 55% carbohydrate, 35% fat, and 10% to 15% protein) for managing diabetes. Carbohydrates impact blood sugar levels the most, so a moderate intake is crucial. The fat percentage is lower to reduce the risk of cardiovascular issues, common in diabetics. Protein intake is moderate for muscle maintenance. Choice A has higher fat and lower carbohydrate, not ideal for diabetes. Choice B has too high carbohydrate, which can spike blood sugar. Choice D has the highest carbohydrate percentage, which is not recommended for diabetes management.