Nursing Process Practice Questions Quizlet

Questions 71

ATI RN

ATI RN Test Bank

Nursing Process Practice Questions Quizlet Questions

Question 1 of 5

When evaluating the effectiveness of nursing interventions for sinusitis discomfort, which of the following does the nurse assess?

Correct Answer: C

Rationale: The correct answer is C: Amount and color of sinus drainage. Assessing the amount and color of sinus drainage is crucial in evaluating the effectiveness of nursing interventions for sinusitis discomfort as it indicates the presence of infection or inflammation. Changes in color or amount can signify improvement or worsening of the condition. WBC count (A) may indicate infection but doesn't directly reflect sinusitis discomfort. Capillary refill (B) assesses circulation, not sinusitis. Comfort level (D) is subjective and can vary among individuals, making it less reliable for assessing the effectiveness of interventions.

Question 2 of 5

Why would a Heimlich maneuver be performed on a client?

Correct Answer: B

Rationale: The Heimlich maneuver is performed to clear the airway if a client is choking and cannot speak or breathe after swallowing food. Step 1: Assess the situation and confirm airway obstruction. Step 2: Stand behind the client, wrap your arms around their waist, and deliver upward abdominal thrusts. Step 3: Repeat thrusts until the object is dislodged. Other choices are incorrect as they do not address airway obstruction. A: Increasing medication absorption is not a purpose of the Heimlich maneuver. C: Preventing falls and D: Maintaining extremities in proper position are not related to choking emergencies.

Question 3 of 5

During the physical assessment, the nurse recalls that the areas most frequently affected by multiple sclerosis are the:

Correct Answer: C

Rationale: Rationale for Choice C (Correct Answer): 1. Multiple sclerosis (MS) commonly affects the optic nerve and chiasm. 2. MS is characterized by demyelination of nerves, leading to visual disturbances. 3. Optic nerve involvement results in vision problems, such as blurred vision. 4. Chiasm involvement can cause visual field deficits and color perception changes. Summary of Other Choices: A: Lateral, 3rd, and 4th ventricles - Incorrect. MS primarily affects the central nervous system, not ventricles. B: Pons, medulla, and cerebral peduncles - Incorrect. While these areas are part of the brainstem, they are not commonly affected in MS. D: Above areas - Incorrect. This choice is vague and does not specify any specific areas affected by MS.

Question 4 of 5

Aling Nena, 68 years old, had a MVA and underwent surgery for hip fracture. Two days post-surgery, she suddenly complained of chest heaviness despite the absence of cardiac history. What is the nursing priority?

Correct Answer: C

Rationale: The correct answer is C: administer oxygen via face mask. Given Aling Nena's sudden chest heaviness post-surgery, oxygen administration is the priority to ensure adequate oxygenation. This can help rule out potential respiratory issues or hypoxemia, which are common post-operatively. Providing oxygen promptly can prevent further complications such as respiratory distress or cardiac compromise. Documenting the pain characteristics (choice A) can be done after ensuring immediate physiological needs are met. Offering analgesics (choice B) without confirming the underlying cause can mask symptoms and delay appropriate interventions. Informing the physician (choice D) is important but not as urgent as addressing potential respiratory compromise.

Question 5 of 5

A guest who is diabetic attended a bridal affair. The guest started to tremble and started to feel dizzy. Luckily a nurse is present. The best action for the nurse to take is to:

Correct Answer: D

Rationale: The correct answer is D: give the guest a glass of orange juice. This is the best action because the guest is likely experiencing hypoglycemia due to being diabetic. Orange juice contains fast-acting sugar that can quickly raise blood sugar levels. Encouraging the guest to eat some (choice A) may take longer to have an effect. Calling the guest's personal hygiene (choice B) is irrelevant to the situation. Offering the guest a peppermint (choice C) will not effectively raise blood sugar levels.

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