ATI RN
Pharmacology and the Nursing Process Test Bank Questions
Question 1 of 9
The LPN is caring for a patient in the preoperative period who, even after verbalizing concerns and having questions answered, states, “I know I am not going to wake up after surgery.” Which of the following actions should the nurse take?
Correct Answer: C
Rationale: The correct answer is C: Inform the registered nurse. This is the best course of action as the LPN should escalate the situation to a higher level of care by involving the registered nurse who can further assess the patient's concerns and provide appropriate interventions. A. Reassuring the patient may not address the underlying fear and may not be sufficient to alleviate their anxiety. B. Providing statistics about surgery death rates may further escalate the patient's fears and anxiety, causing more harm than good. D. Involving the family to comfort the patient may not address the patient's specific concerns and may not be within the family's scope of understanding or expertise to effectively address the situation. Informing the registered nurse allows for a more comprehensive assessment and appropriate intervention to address the patient's fears and concerns in a holistic manner.
Question 2 of 9
The LPN is caring for a patient in the preoperative period who, even after verbalizing concerns and having questions answered, states, “I know I am not going to wake up after surgery.” Which of the following actions should the nurse take?
Correct Answer: C
Rationale: The correct answer is C: Inform the registered nurse. This is the best course of action as the LPN should escalate the situation to a higher level of care by involving the registered nurse who can further assess the patient's concerns and provide appropriate interventions. A. Reassuring the patient may not address the underlying fear and may not be sufficient to alleviate their anxiety. B. Providing statistics about surgery death rates may further escalate the patient's fears and anxiety, causing more harm than good. D. Involving the family to comfort the patient may not address the patient's specific concerns and may not be within the family's scope of understanding or expertise to effectively address the situation. Informing the registered nurse allows for a more comprehensive assessment and appropriate intervention to address the patient's fears and concerns in a holistic manner.
Question 3 of 9
The nurse should include in the patient’s teaching plan that if the patient does not take the vitamin B12, which one of the following will develop?
Correct Answer: C
Rationale: The correct answer is C: Pernicious anemia. Vitamin B12 is essential for the production of red blood cells, and its deficiency can lead to pernicious anemia, characterized by decreased red blood cell production. Without adequate vitamin B12, the body cannot properly utilize iron, leading to anemia. Iron deficiency anemia (choice A) is a result of insufficient iron levels, not vitamin B12 deficiency. Sickle cell anemia (choice B) is a genetic disorder affecting hemoglobin, not related to vitamin B12 deficiency. Acquired haemolytic anemia (choice D) is caused by the premature destruction of red blood cells, not by vitamin B12 deficiency.
Question 4 of 9
A nurse who is caring for an unresponsive client formulates the nursing diagnosis, 'Risk for Aspiration related to reduced level of consciousness.' The nurse documents this nursing diagnosis as correct based on the understanding that which of the following is a characteristic of this type of diagnosis?
Correct Answer: A
Rationale: The correct answer is A: Is written as a two-part statement. This is because a nursing diagnosis typically consists of two parts: the problem (risk for aspiration) and the related factor (reduced level of consciousness). By using a two-part statement, the nurse clearly identifies the client's current health problem and the underlying reason for it. This format helps in developing appropriate nursing interventions to address the issue. Choice B is incorrect because the nursing diagnosis does not describe the client's response to a health problem; it identifies the potential risk for aspiration. Choice C is incorrect as the diagnosis does not focus on enhancement but rather on potential harm. Choice D is incorrect because the nursing diagnosis is based on the available evidence of the client's reduced level of consciousness, which poses a risk for aspiration.
Question 5 of 9
For a patient receiving furosemide, the nurse evaluates the medication as being effective if which of the following effects occurs?
Correct Answer: A
Rationale: The correct answer is A: Urine output increased. Furosemide is a loop diuretic that works by increasing urine output, thus helping to reduce fluid volume in the body. This effect is crucial in managing conditions like heart failure and edema. Increased urine output indicates that the medication is working as intended. Choice B: Heart rate increased is incorrect as furosemide does not directly affect heart rate. Choice C: Serum potassium decreased is incorrect as furosemide can lead to potassium loss, but this is not the primary indicator of its effectiveness. Choice D: Pulse pressure increased is incorrect as furosemide does not typically impact pulse pressure.
Question 6 of 9
When monitoring for hypernatremia, the nurse should assess the client for:
Correct Answer: C
Rationale: The correct answer is C: Confusion. Hypernatremia is an electrolyte imbalance characterized by high sodium levels in the blood. Confusion is a common symptom as high sodium levels can affect brain function. Dry skin (A) is more indicative of dehydration, tachycardia (B) is a symptom of various conditions, and pale coloring (D) is not specific to hypernatremia. Confusion is a key indicator that the nurse should assess for when monitoring for hypernatremia.
Question 7 of 9
When administering a blood transfusion to a client with multiple traumatic injuries, the nurse monitors closely for evidence of a transfusion reaction. Shortly after the transfusion begins, the client complains of chest pain, nausea and itching. When urticarial, tachycardia, and hypotension develop, the nurse stops the transfusion and notifies the physician. The nurse suspects which type of hypersensitivity reaction?
Correct Answer: A
Rationale: The correct answer is A: Type I (immediate, anaphylactic) hypersensitivity reaction. In this scenario, the client experiences symptoms shortly after the transfusion starts, such as chest pain, nausea, itching, urticaria, tachycardia, and hypotension, which are indicative of an immediate hypersensitivity reaction. Type I reactions involve the release of histamine and other inflammatory mediators from mast cells and basophils, leading to the symptoms described. The nurse's prompt action of stopping the transfusion and notifying the physician aligns with managing this type of reaction. Incorrect choices: B: Type II (cytolytic, cytotoxic) hypersensitivity reaction - This type of reaction involves antibodies targeting specific cells, leading to their destruction. The symptoms described in the scenario are not consistent with this type of reaction. C: Type III (immune complex) hypersensitivity reaction - This type of reaction involves the formation of immune complexes that deposit in tissues, causing
Question 8 of 9
A client is receiving chemotherapy to treat breath cancer. Which assessment finding indicates a fluid and electrolyte imbalance induced by chemotherapy?
Correct Answer: A
Rationale: The correct answer is A: A urine output of 400 ml in 8 hours indicates a fluid and electrolyte imbalance induced by chemotherapy. Chemotherapy can cause renal damage, leading to decreased urine output. This can result in fluid retention and electrolyte imbalances. Choice B is incorrect because a serum potassium level of 3.6 mEq/L is within the normal range. Choice C is incorrect as the blood pressure readings provided are within the normal range. Choice D is incorrect as dry oral mucous membranes and cracked lips are more indicative of dehydration rather than a fluid and electrolyte imbalance induced by chemotherapy.
Question 9 of 9
Which of the ff is the diagnostic sign for pericarditis?
Correct Answer: B
Rationale: The correct answer is B: Pericardial friction rub. This is a key diagnostic sign of pericarditis due to the inflammation of the pericardial layers causing a rough, grating sound heard upon auscultation. Precordial pain (A) is a common symptom but not a specific diagnostic sign. Hypotension (C) and rapid/labored respirations (D) are not typically associated with pericarditis. Therefore, the presence of a pericardial friction rub is crucial in confirming the diagnosis of pericarditis.