ATI RN
Nursing Process Practice Questions Quizlet Questions
Question 1 of 9
Maintaining the infusion rate of hyperalimentation solutions is a nursing responsibility. What side effects would you anticipate from too rapid infusion rate?
Correct Answer: D
Rationale: Rationale: 1. Rapid infusion of hyperalimentation solutions can lead to circulatory overload due to increased fluid volume in the circulatory system. 2. Circulatory overload can result in symptoms such as hypertension, tachycardia, and edema. 3. Hypoglycemia can occur as a result of excess insulin release due to the sudden increase in glucose from the hyperalimentation solution. Summary: A. Cellular dehydration and potassium: Incorrect. Rapid infusion would lead to fluid overload, not dehydration. B. Hypoglycemia and hypovolemia: Incorrect. Hypovolemia is unlikely with rapid infusion, and hypoglycemia is a possible side effect. C. Potassium excess and CHF: Incorrect. Rapid infusion may cause circulatory overload, not CHF, and potassium excess is not a common side effect. D. Circulatory overload and hypoglycemia: Correct. These are the most likely side effects of rapid
Question 2 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.
Question 3 of 9
The nurse observes the client as he walks into the room. What information will this provide the nurse?
Correct Answer: A
Rationale: The correct answer is A because observing the client's gait while walking can provide valuable information about their physical mobility, balance, coordination, and any potential musculoskeletal issues. This assessment helps the nurse determine if the client requires any assistance, mobility aids, or further evaluation by a healthcare provider. Choices B and C are incorrect as observing gait does not directly provide information on personality or psychosocial status. Choice D is incorrect as gait observation is not specifically related to the rate of recovery from surgery. In summary, observing the client's gait is important for assessing physical mobility and identifying potential issues, making it the most relevant choice in this context.
Question 4 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 5 of 9
For a client with an exacerbation of rheumatoid arthritis, the physician prescribes the corticosteroid prednisone (Deltasone). When caring for this client, the nurse should monitor for which adverse drug reactions?
Correct Answer: A
Rationale: The correct answer is A. Prednisone is a corticosteroid that can cause adverse reactions such as increased weight due to fluid retention, hypertension due to sodium retention, and insomnia due to its stimulating effects. Vaginal bleeding, jaundice, inflammation, stupor, breast lumps, pain, dyspnea, numbness, and headache are not commonly associated with prednisone use. Monitoring for weight changes, blood pressure, and sleep patterns is essential when administering prednisone to a client with rheumatoid arthritis for early detection and management of adverse reactions.
Question 6 of 9
Wilma knew that the maximum time when suctioning James is
Correct Answer: C
Rationale: The correct answer is C (30 seconds) because the maximum recommended time for suctioning a patient is typically around 10-15 seconds for each pass. Prolonged suctioning can lead to tissue damage, hypoxia, and increased risk of infection. In this case, given the patient's symptoms and medical history (vomiting, weight loss, dehydration, hypotension), it is crucial to limit suction time to prevent further complications. Choices A, B, and D are incorrect as they exceed the safe duration for suctioning and increase the risk of harm to the patient. Choice D, in particular, is significantly longer than the recommended time and could pose serious risks to the patient's health in this situation.
Question 7 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 potential causes of their fatigue, leading to a more in-depth exploration of the issue. Option A focuses on stress, not necessarily fatigue. Option C is too specific and may not uncover underlying causes. Option D assumes sleep duration is the only factor contributing to fatigue.
Question 8 of 9
Which of the following medications should then nurse explain may cause headache as a side effect?
Correct Answer: B
Rationale: The correct answer is B: Clonidine (Catapres). Clonidine is known to cause headache as a side effect due to its mechanism of action affecting blood pressure regulation in the brain. Furosemide (A) is a diuretic that typically causes electrolyte imbalances, not headaches. Atenolol (C) is a beta-blocker used for hypertension, which can cause fatigue but not typically headaches. Adalat (D) is a calcium channel blocker that usually causes peripheral edema, not headaches.
Question 9 of 9
After a transsphenoidal adenohypophysectomy, a client is likely to undergo hormone replacement therapy. A transsphenoidal adenohypophysectomy is performed to treat which type of cancer?
Correct Answer: C
Rationale: After a transsphenoidal adenohypophysectomy, hormone replacement therapy is needed due to the removal of the pituitary gland. This surgery is typically done to treat pituitary carcinoma, making choice C the correct answer. Pituitary carcinoma is a type of cancer that affects the pituitary gland. Choices A, B, and D are incorrect because they do not involve the pituitary gland. Esophageal carcinoma affects the esophagus, laryngeal carcinoma affects the larynx, and colorectal carcinoma affects the colon and rectum. Therefore, the correct choice, C, is the only one related to the pituitary gland and the procedure described.