ATI LPN
ATI PN Fundamentals 2023 NS117 Winter 2023 Monroe College NY PN Questions
Extract:
Question 1 of 5
A nurse is collecting data on a client who is receiving a unit of PRBCs. Which of the following findings is a manifestation of an allergic transfusion reaction?
Correct Answer: D
Rationale: Wheezing indicates an allergic reaction to the transfusion, a hypersensitivity response to donor blood components.
Question 2 of 5
A charge nurse in a long-term care facility is observing another nurse who is inserting an indwelling urinary catheter into a female client. Which of the following actions by the nurse should prompt the charge nurse to intervene?
Correct Answer: C
Rationale: Separating the labia with the dominant hand violates sterile technique; the non-dominant hand should be used.
Question 3 of 5
A nurse is collecting data on a client who has circulatory overload. Which of the following findings should the nurse expect?
Correct Answer: A
Rationale: Tachycardia occurs as the heart pumps faster to manage excess fluid volume in circulatory overload.
Question 4 of 5
A nurse is assisting with the care of a school-age child who has respiratory failure due to pneumonia. Which of the following positions should the nurse encourage to allow maximal lung expansion?
Correct Answer: D
Rationale: The upright position enhances lung compliance and gas exchange, maximizing lung expansion.
Question 5 of 5
A nurse is caring for a client who has pneumonia and has been receiving oxygen therapy for several days. When collecting data from the client, the nurse should identify which of the following findings as an indication of an adverse effect of oxygen therapy?
Correct Answer: B
Rationale: Cracks in oral mucous membranes indicate dryness from oxygen therapy, an adverse effect due to reduced moisture.