ATI Pharmacology PN Proctored Test Bank Exam With 100% Correct
Questions and Answers with Explanations
A nurse is caring for a client who was
... [Show More] admitted to a long-term care facility for rehabilitationafter a total hip
arthroplasty. At which of the following times should the nurse begin discharge planning?
A. One week prior to theclient‟s discharge
-incorrect: Beginning to plan for the client‟s discharge a week prior to the event might not allowsufficient time for
planning. The nurse should begin discharge planning at the time of admission.
B. Upon the client‟s admission to the carefacility
-The nurseshould begin discharge planning at thetimethat theclient is admitted to thefacility.
C. Oncethe discharge date is identified
-incorrect: Beginning to plan for theclient‟s dischargeoncethe discharge dateis identified mightnot allow sufficient
time for planning. The nurse should begin discharge planning at the time of admission.
D. When theclient addresses the topic with the nurse
-incorrect: Beginning to plan for theclient‟s dischargeoncethe discharge dateis identified mightnot allow sufficient
time for planning. The nurse should begin discharge planning at the time of admission.
A nurse is preparing to administer a cleansing enema to a client. Which of the followingactions should the
nurse plan to take?
A. Insert the rectal tube 15.2 cm (6 in)
-incorrect: The nurseshould insert the rectal tube 7 to 10 cm (3to 4 in)
B. Wearsterile gloves to insert the tubing
-incorrect: The nurseshould wearclean (nonsterile) gloves to preventcontamination.
C. Position theclienton his left side
-Positioning is an important aspect of administering an enema. Having the client lie on his leftside facilitates the
flow of the enema solution into the sigmoid and descending colon.
D. Hold thesolution bag 91cm (36inch) abovetheclient‟s rectum
-incorrect: The nurseshould hold thesolution bag 30 cm (12 in) abovetheclient‟s rectum for alow enema and 45
cm (18 in) for a high enema. If the nurse holds the solution bag too high, thesolution might run in too fast, causing
discomfort and spasms that make retaining the enema more difficult.
A nurse is caring for a client who has bilateral cats on her hands. Which of the followingactions should the
nursetake when assisting theclient with feeding?
A. Sit at the bedside when feeding theclient
-The nurse should avoid appearing to be in a hurry. Sitting at the bedside provides the client withthe nurse‟s full
attention during the feeding
B. Order pureed foods
-incorrect: Without any mouth or throat injuries that make chewing or swallowing difficult, theclient should be
served foods of an appropriate variety of textures. Pureed foods are for clients who cannot chew, have difficulty
swallowing, or do not haveteeth.
C. Makesurefeedings are provided at room temperature
-incorrect: The nurseshould ask the client if thefood is the correct temperature
D. Offer theclient a drink of fluid afterevery bite
-incorrect: If the client is unable to communicate, the nurse should offer the client fluids after every 3 or 4
mouthfuls. However, there is no indication that this client is unable to communicate.Therefore, the client should tell
the nurse when she would like a drink.
A nurse is administering an IM injection to a 5-month-old infant. Which of the followinginjection sites
should the nurse use?
A. Deltoid
-incorrect: The nurse can use the deltoid muscle for injecting small volumes of medication forchildren 18 months
of age or older, but its proximity to several nerves and arteries make it a riskier choice.
B. Ventrogluteal
-incorrect: This is a safesitefor IM injections forclients older than 7 months.
C. Vastuslateralis
-The nurse should use the vastus lateralis site over the anterior thigh for IM injections for infantsand children.
D. Dorsogluteal
-incorrect: This site is unsafe to use because of its proximity to the sciatic nerve and the superiorgluteal nerve and
artery.
A nurse is caring for a client who has major fecal incontinence and reports irritation in theperianal area.
Which of the following actions should the nurse takefirst?
A. Apply a fecal collection system
-incorrect: The nurse should apply a fecal collection system to divert the feces away from thearea of skin
irritation; however, there is another action the nurseshould takefirst.
B. Apply a barrier cream
-incorrect: The nurse should apply a barrier cream to decrease skin breakdown in the perianalarea from the
feces; however, thereis another action the nurseshould take first.
C. Cleanse and drythe area
-incorrect: The nurse should cleanse and dry the perianal area to decrease skin irritation;however, there
is another action the nurseshould take first.
D. Check theclient‟s perineum
-The nurse should apply the nursing process priority-setting framework to plan care and prioritize nursing actions.
Each step of the nursing process builds on the previous step, beginningwith an assessment or data collection. Before
the nurse can formulate a plan of action, implementa nursing intervention, or notify a provider of a change in the
client‟s status, the nurse must first collect adequate data from the client. Assessing or collecting additional data
will provide the nurse with knowledge to make an appropriate decision. The priority nursing action is for the nurseto
collect more data by assessing the area of irritation.
A nurse is caring for a client who is receiving IV therapy via a peripheral catheter. The nurseshould identifythat
which of the following findings is an indication of infiltration?
A. Redness at theinfusion site
-incorrect: Redness at the infusion siteis an indication of phlebitis or infection.
B. Edema at theinfusion site
-Edema duetofluid entering subcutaneous tissueis an indication of infiltration.
C. Warmth at theinfusion site
-incorrect: Warmth at theinfusion siteis an indication of phlebitis or infection.
D. Oozing of blood at the infusion site
-incorrect: Oozing of blood at theinfusion siteis an indication that theIVsystem is not intact.
A nurse is caring for a client who reports not sleeping at night, which interferes with her ability to function
during the day. Which of the following interventions should the nurse suggestto this client?
A. Avoid beverages thatcontain caffeine
-Caffeineis a stimulant. The nurseshould suggest that theclient avoid caffeinated beverages.
B. Take a sleep medication regularly at bedtime
-incorrect: Sleep-promoting medication is a last resort. The nurse should not suggest this type ofmedication for the
client before recommending other nonpharmacological interventions.
C. Watch television for30 minutes in bed to relax prior to falling asleep
-incorrect: Clients should associate going to bed with sleep. Therefore, the client should not getinto bed until she is
sleepy.
D. Advisetheclient to take several naps during the day
-incorrect: Napping in the daytime can prevent sound sleep at night
A nurse is conducting an admission interview with a client. Which of the following pieces ofassessment
information should the nurse collect during the introductory phase of the interview?
A. Clients level of comfort and ability to participate in the interview
-The nurse should assess the client‟s level of comfort and establish a rapport during the introductory or
orientation phase. The nurse should engage in active listening and present a relaxed attitude to place the client at
ease and encourage client participation. This will assist thenursein gaining the necessary data to formulate
appropriate nursing diagnoses and outcomes.
B. Previous illnesses and surgeries
-incorrect: The nurseshould assesstheclient‟s health history, including previous illnesses andsurgeries, during the
working phase of the interview.
C. Eventssurrounding theclient‟s recent illness
-incorrect: The nurseshould assesstheclient‟s health history, including events surrounding therecent or current illness,
during the working phase of the interview.
D. Sociocultural history
-incorrect: The nurseshould assess theclient‟ssociocultural history during the working phaseofthe interview.
A nurse is planning to collect a stool specimen for ova and parasites from a client who has diarrhea. Which of
thefollowing actions should the nursetake when collecting thespecimen?
A. Instruct theclient to defecate into thetoilet bowl
-incorrect: The nurse should have the client defecate into a bedpan or a container for stoolcollection. The
toilet water can dilute and contaminate the liquid specimen.
B. Transfer thespecimen to a sterilecontainer
-incorrect: The nurse should place the stool specimen in a clean container using a tonguedepressor.
C. Refrigeratethecollected specimen
-incorrect: The nurse should send the collected stool specimen immediately to the laboratory after labeling the
specimen properly to prevent contamination with microorganisms and keep thespecimen from getting cold.
D. Placethestool specimen collection container in a biohazard bag
-The nurse should place the specimen collection container in a biohazard bag with the client label on the
container and the bag for easy identification. This will also prevent contaminationwith microorganisms.
A nurse is caring for a client who has a tracheostomy and requires suctioning. Which of thefollowing actions
should the nursetake?
A. Hyperoxygenatetheclient beforesuctioning
-The nurse should use a manual resuscitation bag to hyper oxygenate the client for severalminutes prior to
suctioning.
B. Insert thecatheter during exhalation
-incorrect: The nurseshould insert thecatheter during inhalation
C. Applysuction during insertion of thecatheter
-incorrect: Applying suction while inserting the catheter increases the risk of damage to thetracheal mucosa
and removes oxygen from the airways.
D. Applysuction for no morethan 15 secs
-incorrect: The nurseshould applysuction for no morethan 10 seconds
A nurse is providing teaching to a client regarding protein intake. Which of the followingfoods should the
nurseinclude as an example of an incomplete protein?
A. Eggs
-incorrect: this is a complete protein, contains all of the essential amino acids necessary for thesynthesis of
protein in the body.
B. Soybeans
-incorrect: this is a complete protein, contains all of the essential amino acids necessary for thesynthesis of
protein in the body.
C. Lentils
-Incomplete proteins are missing 1 or more of the essential amino acids necessary for the synthesis of protein
in the body. Examples of incomplete proteins include lentils, vegetables,grains, nuts, and seeds.
D. Yogurt
-incorrect: this is a complete protein, contains all of the essential amino acids necessary for thesynthesis of
protein in the body.
A nurse is performing an abdominal assessment of a client. Which of the following positionsshould the nurse
tell the client to assume for this examination?
A. Lithotomy
-incorrect: Thelithotomy position is useful for gynecologicalexaminations.
B. Lateral
-incorrect: The lateral recumbent, or side-lying position, limits access to the abdomen. Thisposition is useful
when auscultating the heart to detect murmurs.
C. Supine
-The nurse should tell the client to assume the supine position to promote relaxation of theabdominal
muscles. Having the client bend the knees enhances relaxation of the stomach muscles.
D. Sims
-incorrect: The Sims‟ position limits access to the abdomen. This position is useful for rectal [Show Less]