ATI RN
Nursing Process Test Questions Questions
Question 1 of 5
Which of the ff. would the nurse explain to a patient is the main purpose of a hearing aid?
Correct Answer: D
Rationale: The correct answer is D: Improve ability to hear. A hearing aid is designed to improve a person's ability to hear by amplifying sound. This helps individuals with hearing loss to better understand speech and sounds in their environment. A: Amplifying background noise is not the main purpose of a hearing aid. It may actually hinder the user's ability to focus on important sounds. B: Amplifying musical sounds is not the primary function of a hearing aid. The main focus is on improving speech understanding. C: Occluding the ear is not the purpose of a hearing aid. It is meant to enhance hearing, not block sound.
Question 2 of 5
Which of the following is the most critical intervention needed for a client with myxedema coma?
Correct Answer: A
Rationale: The correct answer is A: Administering an oral dose of levothyroxine (Synthroid). In myxedema coma, there is severe hypothyroidism leading to altered mental status, hypothermia, and organ failure. Administering levothyroxine is crucial to replace the deficient thyroid hormone rapidly and restore metabolic function. Warming the client (B) is important but secondary to addressing the underlying hormonal imbalance. Measuring intake and output (C) is essential for overall assessment but not the most critical intervention. Maintaining a patent airway (D) is always important in any medical emergency but does not directly address the primary issue of hypothyroidism in myxedema coma.
Question 3 of 5
Mrs. Silang, a 52-year old female, is experiencing advanced hepatic cirrhosis now complicated by hepatic encephalopathy. She is confused, restless, and demonstrating asterixis. The nurse has formulated the nursing diagnosis: Altered thought processes related to which of the following?
Correct Answer: C
Rationale: The correct answer is C: increased serum ammonia levels. In hepatic encephalopathy, the liver is unable to metabolize ammonia, leading to its accumulation in the bloodstream, causing altered thought processes. This results in confusion and asterixis. Massive ascites formation (choice A) is related to fluid accumulation in the peritoneal cavity, not directly linked to altered thought processes. Fluid volume excess (choice B) is a general fluid imbalance issue, not specific to hepatic encephalopathy. Altered clotting mechanism (choice D) is more associated with hepatic dysfunction leading to impaired clotting factors, not directly linked to altered thought processes.
Question 4 of 5
Mr. Umali, 52-year-old male is being evaluated for acute ulcerative colitis. im preparing Mr. Umali for a barium enema, the nurse can expect that he will be:
Correct Answer: A
Rationale: The correct answer is A because cathartics can exacerbate ulcerative colitis symptoms by increasing bowel motility and causing further inflammation. Giving an oil retention enema (choice B) is not necessary for a barium enema. Ingesting radiopaque tablets (choice C) is not typically part of the preparation for a barium enema. Positioning the patient in a high Fowler's position (choice D) is not a specific requirement following the procedure. Overall, avoiding cathartics is crucial in patients with acute ulcerative colitis to prevent worsening of symptoms during the barium enema.
Question 5 of 5
One of the side effects of INH administration is peripheral neuropathy. To prevent this effect, Nurse Carlos teaches Andrew to:
Correct Answer: C
Rationale: Step-by-step rationale: 1. INH (Isoniazid) can lead to peripheral neuropathy due to vitamin B6 deficiency. 2. Pyridoxine is vitamin B6, which helps prevent neuropathy. 3. Supplementing with pyridoxine can counteract the deficiency caused by INH. 4. Thus, option C, supplementing the diet with pyridoxine, is the correct choice. Summary: - Option A is incorrect as a low cholesterol diet does not address the vitamin B6 deficiency. - Option B is incorrect as excessive bed rest does not prevent neuropathy. - Option D is incorrect as sun exposure is not related to the prevention of peripheral neuropathy.