ATI RN
Pharmacology and the Nursing Process Test Bank Questions
Question 1 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 2 of 9
To supplement a diet with foods high in potassium, the nurse should recommend the addition of:
Correct Answer: A
Rationale: The correct answer is A: Fruits such as bananas. Bananas are high in potassium, which is essential for various bodily functions like muscle contractions and maintaining fluid balance. Fruits are a natural source of potassium and are easily incorporated into the diet. Milk and yogurt (B) are good sources of calcium, not potassium. Green leafy vegetables (C) are nutritious but may not provide as much potassium as fruits. Nuts and legumes (D) are good sources of protein and healthy fats but are not as rich in potassium as fruits like bananas.
Question 3 of 9
To reduce symptoms of early morning stiffness in a ptient who has rheumatoid arthritis, the nurse can encourage the patient to:
Correct Answer: A
Rationale: The correct answer is A: take a hot tub bath or shower in the morning. This is effective as the warm water helps to relax muscles and joints, reducing stiffness. It also improves circulation, which can alleviate morning stiffness in patients with rheumatoid arthritis. Incorrect choices: B: Putting joints through passive ROM before active movement may exacerbate stiffness if not done properly. C: Sleeping with a hot pad may provide temporary relief but does not address the root cause of morning stiffness. D: Taking aspirin can help with pain but does not directly address stiffness. Waiting 15 minutes before moving may not be as effective as soaking in warm water.
Question 4 of 9
Which of the following measures will not help correct the patient’s condition
Correct Answer: C
Rationale: Step-by-step rationale: 1. Providing oral care does not directly address fluid balance or hydration status. 2. Oral care focuses on maintaining oral hygiene and preventing infections. 3. Choices A, B, and D all involve fluid intake to address dehydration. 4. Offering large amounts of fluid, enteral or parenteral fluids, and small volumes at frequent intervals all aim to correct the patient's condition by replenishing lost fluids. Summary: Choice C is incorrect because oral care does not directly address the patient's dehydration. Choices A, B, and D are better options as they focus on fluid replacement to correct the patient's condition.
Question 5 of 9
A 52-year old female tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client’s lump is cancerous?
Correct Answer: C
Rationale: The correct answer is C: Non-mobile mass with irregular edges. A non-mobile mass with irregular edges is more likely to be cancerous as it indicates potential infiltration into surrounding tissues. This finding raises suspicion for malignancy as cancerous lumps tend to have irregular shapes due to their invasive nature. In contrast, options A and B describe characteristics of benign masses, such as mobile, soft, and easily delineated. Option D indicates no palpable lymph nodes, which does not directly correlate with the characteristics of the breast lump. Therefore, option C is the most concerning and indicative of a potentially cancerous lesion based on the assessment findings provided.
Question 6 of 9
A narcotic analgesic is ordered for postoperative pain. Why are narcotics given in low doses to the laryngectomy patient?
Correct Answer: A
Rationale: The correct answer is A because narcotics in high doses can depress the respiratory rate and cough reflex, which can be especially dangerous for a laryngectomy patient due to the risk of airway compromise. Low doses can provide pain relief without significant respiratory depression. Choices B and C are incorrect because narcotics typically do not increase respiratory tract secretions or cause stomal edema. Choice D is incorrect because while narcotics can potentially cause addiction, this is not the primary reason for giving low doses to laryngectomy patients.
Question 7 of 9
The nurse understands that which of the ff. best describes the action of enalapril maleate (Vasotec)?
Correct Answer: A
Rationale: Step-by-step rationale for why choice A is correct: 1. Enalapril maleate is an angiotensin-converting enzyme (ACE) inhibitor. 2. ACE inhibitors like enalapril maleate block the conversion of angiotensin I to angiotensin II. 3. By inhibiting the formation of angiotensin II, enalapril maleate decreases the levels of angiotensin II. 4. Angiotensin II is a potent vasoconstrictor, so decreasing its levels leads to vasodilation and decreased blood pressure. Summary of why other choices are incorrect: - Choice B: Enalapril maleate primarily dilates arterioles by decreasing angiotensin II levels, not veins. - Choice C: Enalapril maleate does not directly adjust extracellular volume; it primarily affects the renin-angiotensin-aldosterone system. - Choice D: Enalapril maleate
Question 8 of 9
A new nurse writes the following nursing diagnoses on a patient’s care plan. Which nursing diagnosis will cause the nurse manager to intervene?
Correct Answer: B
Rationale: The correct answer is B: Hemorrhage. The nurse manager would intervene because hemorrhage is a life-threatening condition requiring immediate attention. Wandering (A), urinary retention (C), and impaired swallowing (D) are important assessments but do not pose the same level of immediate risk as hemorrhage. The nurse manager would prioritize addressing the hemorrhage to ensure the patient's safety and well-being.
Question 9 of 9
20-year old Mr. Ang fell off from his horse, and sustained a lft hip fracture. Buck’s extension traction is applied. The following statements are true about Buck’s extension traction except:
Correct Answer: D
Rationale: The correct answer is D because Buck's extension traction is not used definitively to treat fractures in children due to their growing bones. Instead, it is used temporarily in adults to control muscle spasm and pain. - A: Correct - Buck's extension traction is indeed used temporarily in adults to control muscle spasm and pain. - B: Correct - Buck's extension traction is applied by an orthopedic surgeon under aseptic conditions using wires and pins. - C: Correct - The pulling force in Buck's extension traction is indeed transmitted to the musculoskeletal structures. Therefore, the incorrect option is D as Buck's extension traction is not used definitively to treat fractures in children.