ATI RN
Nursing Process Final Exam Questions Questions
Question 1 of 9
The nurse expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketonic syndrome (HHNS). Which other laboratory finding should the nurse anticipate?
Correct Answer: D
Rationale: Step 1: In HHNS, there is severe hyperglycemia leading to osmotic diuresis. Step 2: Osmotic diuresis causes loss of potassium in urine, leading to hypokalemia. Step 3: Hypokalemia is a common electrolyte imbalance in HHNS due to excessive urinary loss of potassium. Step 4: Therefore, the nurse should anticipate a below-normal serum potassium level in a client with HHNS. Summary: A: Elevated serum acetone level is seen in diabetic ketoacidosis, not HHNS. B: Serum alkalosis is not typically associated with HHNS. C: Serum ketone bodies are elevated in diabetic ketoacidosis, not HHNS.
Question 2 of 9
Which of the following would the nurse identify as an abnormal finding?
Correct Answer: C
Rationale: The nurse would identify platelets at 115,000/ul as an abnormal finding because it is below the normal range of 150,000-450,000/ul. Low platelet count can lead to increased bleeding risk. RBC count and hematocrit levels are within normal ranges, making them normal findings. Option D is incorrect as platelets are abnormal.
Question 3 of 9
Which of the ff. is the best explanation of emphysema for a newly diagnosed patient?
Correct Answer: B
Rationale: The correct answer is B because emphysema is characterized by the destruction of the alveoli walls, leading to a loss of elasticity in the lungs. This results in air becoming trapped in the lungs, making it difficult to exhale properly. Explanation for why the other choices are incorrect: A: Inflamed bronchioles causing secretions describe bronchitis, not emphysema. C: Damage to the blood supply isn't a primary feature of emphysema; it's more about lung tissue destruction. D: Large dilated sacs of sputum in the lungs is not an accurate description of emphysema; it's more related to bronchiectasis.
Question 4 of 9
The nurse is aware that multiple sclerosis is a progressive disease of the central nervous system characterized by:
Correct Answer: D
Rationale: Step 1: Multiple sclerosis (MS) is a progressive disease affecting the central nervous system. Step 2: Axon degeneration occurs in MS, leading to impaired nerve signal transmission. Step 3: MS is characterized by sclerosed patches, or plaques, in the nervous system. Step 4: Demyelination of the brain and spinal cord is a hallmark feature of MS. Step 5: Therefore, all of the above choices are correct as they accurately describe key features of MS.
Question 5 of 9
Which of the following is most important discharge teaching for Mr. Dela Isla
Correct Answer: C
Rationale: The correct answer is C: Drug Compliance. After a CVA (stroke), it is crucial for Mr. Dela Isla to understand and adhere to his prescribed medications. Medications help prevent further strokes and manage underlying conditions. Drug compliance ensures optimal treatment outcomes. Emergency Numbers (A) are important but not the priority post-stroke. Relaxation techniques (B) may be helpful but not as critical as medication adherence. Dietary prescription (D) is important but not as urgent as drug compliance in this scenario.
Question 6 of 9
A client who is HIV positive should have the mouth examined for which oral problem common associated with AIDS?
Correct Answer: B
Rationale: The correct answer is B: Creamy white patches. These patches are indicative of oral thrush, a common fungal infection seen in individuals with weakened immune systems like those with AIDS. This infection is caused by Candida albicans. It presents as white patches on the tongue, inner cheeks, or roof of the mouth. Halitosis (A) is bad breath, not specific to AIDS. Carious teeth (C) refers to cavities, not directly related to AIDS. Swollen lips (D) can be a symptom of various oral conditions, but not specific to AIDS. In summary, creamy white patches are a characteristic oral problem associated with AIDS due to opportunistic infections like oral thrush.
Question 7 of 9
A young male client visits a nurse with a complaint of chronic tension headaches. Which of the ff is the most appropriate nursing instruction to manage the client?
Correct Answer: C
Rationale: The correct answer is C: Counselling on alternate therapies. Chronic tension headaches may be exacerbated by stress or other psychological factors, making counseling an appropriate intervention. The nurse can explore relaxation techniques, stress management strategies, or cognitive-behavioral therapy to help the client manage their headaches. A: Instructing the client to monitor for signs of bruising or bleeding is unrelated to tension headaches and not a priority in this situation. B: Suggesting eating and swallowing techniques that reduce the potential for aspiration is not relevant to tension headaches and is not the most appropriate intervention. D: Advising the client to change sleeping positions frequently may help with other types of headaches but is not the most effective strategy for managing chronic tension headaches.
Question 8 of 9
The nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy?
Correct Answer: D
Rationale: Step 1: Levothyroxine (Synthroid) is the synthetic form of the thyroid hormone T4, the main hormone produced by the thyroid gland. Step 2: Levothyroxine is the preferred agent for thyroid hormone replacement therapy in hypothyroidism due to its stable and consistent potency. Step 3: Levothyroxine is well-absorbed by the body and has a long half-life, allowing for once-daily dosing. Step 4: Other choices are incorrect because Methimazole is used to treat hyperthyroidism, Livothyronine is a form of T3 hormone not commonly used for replacement therapy, and Thyroid USP dessicated is derived from animal thyroid glands and has inconsistent hormone content. Summary: Levothyroxine (Synthroid) is the preferred choice for thyroid hormone replacement therapy due to its synthetic nature, stable potency, good absorption, and long half-life. Other options are not
Question 9 of 9
Which of the following statements would be the nurse's response to a famiiy member asking questions about a client's transient ischemic attack (TIA)?
Correct Answer: C
Rationale: The correct answer is C: "It is a temporary interruption in the blood flow to the brain." This response is correct because it accurately describes a transient ischemic attack (TIA) as a temporary condition where blood flow to the brain is briefly interrupted. This explanation is clear, concise, and provides the family member with an accurate understanding of TIA. Choice A is incorrect because it deflects the question and suggests involving the doctor unnecessarily. Choice B is incorrect as it inaccurately states that TIA causes permanent brain damage, which is not true. Choice D is incorrect as it simply defines the acronym without providing any meaningful information about what TIA actually is.