ATI RN
Pharmacology and the Nursing Process Test Bank Questions
Question 1 of 9
Which of the following patients should the nurse monitors because of increased risk for surgical complications?
Correct Answer: B
Rationale: The correct answer is B because the patient's Body Mass Index (BMI) indicates obesity, putting them at higher risk for surgical complications. Obesity is associated with increased risks of infections, delayed wound healing, respiratory issues, and cardiovascular problems post-surgery. Monitoring this patient closely is crucial. Choice A is less likely to have increased surgical complications due to age and condition. Choice C, a 12-year-old, is less likely to have significant surgical complications compared to adults. Choice D, a 17-year-old with gallstones, may have risks but the BMI of the patient in choice B indicates a higher risk.
Question 2 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 3 of 9
The nurse administered neutral protamine Hagedorn (NPH) insulin to a diabetic client at 7am. At what time would the nurse expect the client to be at most risk for a hypoglycemic reaction?
Correct Answer: B
Rationale: Rationale: 1. NPH insulin peaks in 4-12 hours, making 4:00 PM the highest risk time. 2. 10:00 AM is too soon for peak effect. 3. Noon is too early for peak effect. 4. 10:00 PM is too late for peak effect. In summary, B is correct as it aligns with NPH insulin peak time, while other options are too early or too late.
Question 4 of 9
For a client with newly diagnosed cancer, the nurse formulates a nursing diagnosis of Anxiety related to the threat of death secondary to cancer diagnosis. Which expected outcome would be appropriate for this client?
Correct Answer: C
Rationale: The correct answer is C because it focuses on the client actively engaging in reducing tension, which is essential in managing anxiety. This outcome is measurable and client-centered. A: Verbalizing feelings is important, but it does not necessarily lead to reduction in anxiety. B: Not guessing prognosis is helpful, but it does not address the active management of anxiety. D: Stopping seeking information may not be beneficial as knowledge can empower the client in coping with the diagnosis.
Question 5 of 9
The nurse assesses for the characteristic movement of Parkinson’s disease which is a (n):
Correct Answer: C
Rationale: The correct answer is C because pronation-supination of the hand and forearm is a characteristic movement in Parkinson's disease called "pill-rolling tremor." This movement interferes with normal hand activities due to involuntary shaking. A is incorrect because exaggerated muscle flaccidity does not lead to frequent falls in Parkinson's disease. B is incorrect as hyperextension of the back and neck is not a characteristic movement of Parkinson's disease. D is incorrect as it combines all options, which is not accurate.
Question 6 of 9
Which gauge IV cannula should the nurse choose when preparing to initiate a blood transfusion?
Correct Answer: A
Rationale: The correct choice is A: 18 gauge IV cannula for blood transfusion. Larger gauge allows for faster flow rate, crucial for transfusions to prevent clotting. 24, 22, and 28 gauge cannulas are too small for adequate blood flow, leading to potential complications like hemolysis or slowed infusion.
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 man‘s blood type is AB and he requires a blood transfusion. To prevent complications of blood incompatibilities, which blood type may the client receive?
Correct Answer: D
Rationale: The correct answer is D because individuals with AB blood type are considered universal recipients, meaning they can receive blood from any blood type without risking complications due to incompatibility. This is because their blood cells have both A and B antigens and do not produce antibodies against either type. Therefore, the client can safely receive blood from types A, B, AB, or O without adverse reactions. Choices A, B, and C are incorrect because they limit the options for blood transfusion based on the client's AB blood type, which is not necessary given the unique nature of AB blood as universal recipients.
Question 9 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.