Questions 9

ATI RN

ATI RN Test Bank

Nursing Process Final Exam Questions Questions

Question 1 of 5

The nurse has entered a client’s room to find the client diaphoretic (sweat-covered) and shivering, inferring that the client has a fever. How should the nurse best follow up this cue and inference?

Correct Answer: A

Rationale: The correct answer is A: Measure the client’s oral temperature. This is the best follow-up because it directly assesses the client's body temperature, providing objective data to confirm the presence of fever. It is essential to gather accurate information to guide appropriate interventions. Asking a colleague for assistance (B) may not address the immediate need for temperature assessment. Giving the client a clean gown and warm blankets (C) may provide comfort but does not address the need for temperature measurement. Obtaining an order for blood cultures (D) is not the initial priority when the client is showing signs of fever; temperature measurement is the first step in assessing the client's condition.

Question 2 of 5

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 5

A nurse has already set the agenda during a patient-centered interview. What will the nurse do next?

Correct Answer:

Rationale: Correct Answer: B: Ask about the chief concerns or problems. Rationale: 1. This step follows setting the agenda to focus on patient's main issues. 2. Allows nurse to gather essential information for effective care. 3. Builds rapport and shows patient-centered approach. Summary of other choices: A: Introductions are typically done at the beginning of the interview. C: Prematurely ending the interview may hinder rapport and information gathering. D: Administering medications is not the immediate priority after setting the agenda.

Question 4 of 5

The nurse knows which of the following statements about TPN and peripheral parenteral nutrition is true?

Correct Answer: C

Rationale: The correct answer is C because TPN (Total Parenteral Nutrition) is indeed given to patients with fluid restrictions, as it provides complete nutrition including fluids, electrolytes, and nutrients. On the other hand, PPN (Peripheral Parenteral Nutrition) is used for patients without fluid restrictions as it provides partial nutrition. A is incorrect because TPN is typically for long-term use and PPN for short-term use. B is incorrect as the caloric requirement does not determine the type of parenteral nutrition. D is incorrect because both TPN and PPN can be used for patients who are unable to eat orally.

Question 5 of 5

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

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