ATI RN
Nursing Process Questions and Answers PDF Questions
Question 1 of 9
One of the dangers of treating hypernatremia is:
Correct Answer: B
Rationale: The correct answer is B: Cerebral edema. Hypernatremia is an elevated sodium level in the blood, which can lead to osmotic shifts causing water to move out of cells, including brain cells. This can result in cerebral edema, potentially leading to neurological complications. Incorrect choices: A: Red blood cell crenation - This occurs in hypertonic solutions, not hypernatremia. C: Red blood cell hydrolysis - Hypernatremia doesn't directly cause red blood cell hydrolysis. D: Renal shutdown - Hypernatremia can stress the kidneys, but it doesn't typically lead to renal shutdown.
Question 2 of 9
. 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 3 of 9
When you report on duty, your team leader tells you that Mr. MartineHi accidentally received 1000 ml of fluids in 2 hours and that you are to be alert for signs of circulatory overload. Which of the following signs would not be likely to occur?
Correct Answer: C
Rationale: The correct answer is C: Weak, slow pulse. Circulatory overload typically presents with signs of fluid volume excess, such as moist gurgling respirations, distended neck veins, dyspnea, and coughing. A weak, slow pulse is not a characteristic sign of circulatory overload, as the heart rate may actually be elevated due to the increased fluid volume. Therefore, a weak, slow pulse would not be likely to occur in this scenario.
Question 4 of 9
Which of the ff would help a client with an allergic skin reaction to reduce itching and maintain skin intact? Choose all that apply
Correct Answer: D
Rationale: The correct answer is D. Wearing cotton gloves, especially during sleep, helps reduce itching by preventing scratching, which can further irritate the skin. Cotton is a breathable fabric that reduces friction and irritation. A: Humidifying the environment may help in some cases, but it doesn't directly address the itching or maintaining skin integrity. B: Avoiding a skin lubricant is not recommended as it can help moisturize the skin and reduce itching. C: Bathing with a bar soap that contains lye can be harsh and drying, exacerbating the skin reaction.
Question 5 of 9
The nurse is teaching a male client to perform monthly testicular self-examinations. Which of the following points would be appropriate to make?
Correct Answer: A
Rationale: The correct answer is A because testicular cancer is indeed a highly curable type of cancer if detected early through self-examinations. This empowers the client to take control of their health. Choice B is incorrect as testicular cancer is detectable through self-examinations. Choice C is incorrect as testicular cancer is not the number one cause of cancer deaths in males; it is relatively rare. Choice D is incorrect as testicular cancer is more common in younger men, typically between the ages of 15 and 44.
Question 6 of 9
After assessment of a client in an ambulatory clinic, the nurse records the data on the computer. The nurse recognizes which of the following as objective data?
Correct Answer: A
Rationale: The correct answer is A because auscultation of the lungs involves direct observation and measurement, making it objective data. This data is based on what the nurse hears through the stethoscope, which can be verified and measured. Choices B, C, and D involve subjective experiences or interpretations that cannot be directly observed or measured. Complaint of nausea, sensation of burning, and belief in demons are all based on the client's feelings, perceptions, or beliefs, which are subjective and can vary from person to person. Objective data is factual, measurable, and observable, making choice A the correct answer in this scenario.
Question 7 of 9
The nurse understands that a patient with BP readings 164/102 and 176/100 on two separate occasions would be classified in which hypertension category?
Correct Answer: B
Rationale: The correct answer is B: Stage 2 hypertension. The patient's BP readings consistently fall within the range of 160-179 systolic or 100-109 diastolic, which aligns with the criteria for Stage 2 hypertension based on the current guidelines. This classification indicates a higher level of hypertension that requires prompt medical attention and intervention to reduce the risk of complications. Choices A, C, and D are incorrect because they do not correspond to the BP readings provided, falling outside the range for prehypertension, Stage 1 hypertension, and posthypertension.
Question 8 of 9
As the nurse collects data on a patient, which of the following is a symptom that may be found that the patient with anaphylaxis may be experiencing?
Correct Answer: D
Rationale: The correct answer is D: Wheezing. Anaphylaxis is a severe allergic reaction that can lead to airway constriction and difficulty breathing, resulting in wheezing. Wheezing is a common symptom of anaphylaxis due to bronchospasm and airway swelling. Dermatitis (A) is a skin reaction, sinusitis (B) is inflammation of the sinuses, and delirium (C) is a state of mental confusion, which are not typical symptoms of anaphylaxis. Wheezing is a critical symptom in anaphylaxis as it indicates potential airway compromise and the need for immediate medical intervention.
Question 9 of 9
A nurse is conducting a nursing health history. Which component will the nurse address?
Correct Answer: B
Rationale: The correct answer is B: Patient expectations. During a nursing health history, it is essential for the nurse to address the patient's expectations to understand their needs, preferences, and goals for their health care. By focusing on the patient's expectations, the nurse can establish a therapeutic relationship, provide patient-centered care, and tailor the care plan accordingly. A: Nurse's concerns - Incorrect. The nursing health history should prioritize the patient's perspective and needs over the nurse's concerns. C: Current treatment orders - Incorrect. While important, this component focuses on the medical treatment plan rather than the patient's expectations. D: Nurse's goals for the patient - Incorrect. The nurse should collaborate with the patient to set goals that align with the patient's needs and preferences, not impose their own goals.