ATI RN
RN-ATI-Fundamentals-of-Nursing-2023-2024 Questions
Extract:
Question 1 of 5
A nurse is caring for a client who reports xerostomia following radiation therapy to the mandible. Which of the following is an appropriate action by the nurse?
Correct Answer: B
Rationale: The correct answer is B: Provide humidification of the room air. Xerostomia is dry mouth often caused by radiation therapy, which can lead to discomfort and difficulty swallowing. Humidifying the room air can help alleviate dryness, making it easier for the client to breathe and swallow. Alcohol-based mouthwash (
A) can worsen dryness due to its drying effect. Saltine crackers (
C) can be difficult to swallow with a dry mouth. Esophageal speech (
D) is not relevant to xerostomia.
Question 2 of 5
A nurse is planning care for a client who is scheduled for a thoracentesis. Which of the following actions should the nurse plan to take?
Correct Answer: B
Rationale:
Correct
Answer: B - Instruct the client to avoid coughing during the procedure.
Rationale: Coughing during thoracentesis can increase the risk of complications such as lung puncture or bleeding. Instructing the client to avoid coughing helps maintain safety during the procedure by minimizing these risks.
Incorrect
Choices:
A: Positioning the client on the affected side for 4 hours following the procedure is not necessary and may not be beneficial. It does not directly impact the safety or success of the thoracentesis.
C: NPO for 6 hours prior to the procedure is not typically required for a thoracentesis. This action is more common for procedures involving anesthesia or sedation.
D: Placing the client in the prone position during the procedure is not recommended for thoracentesis. The client is usually positioned upright or slightly leaning forward to facilitate the procedure.
Question 3 of 5
A nurse manager is updating protocols for the use of belt restraints. Which of the following guidelines should the nurse manager include?
Correct Answer: B
Rationale: The correct answer is B: Document the client's condition every 15 min. This guideline is crucial to ensure the safety and well-being of the client in restraints. Documenting the client's condition frequently allows for timely identification of any signs of distress, discomfort, or complications related to the use of restraints. This practice helps in monitoring the client's physical and psychological status, enabling prompt intervention if necessary.
Removing the client's restraint every 4 hours (choice
A) is incorrect as it may compromise the client's safety and increase the risk of injury or harm. Requesting a PRN restraint prescription for aggressive clients (choice
C) is inappropriate as restraints should only be used as a last resort and not for convenience. Attaching the restraint to the bed's side rail (choice
D) is unsafe and restricts the client's movement unnecessarily.
Question 4 of 5
A nurse is reviewing a client's cardiac rhythm strips and notes a constant P-R interval of 0.35 seconds. Which of the following dysrhythmias is the client displaying?
Correct Answer: A
Rationale: The correct answer is A: First-degree atrioventricular block. A constant P-R interval of 0.35 seconds indicates a delay in the conduction of electrical impulses from the atria to the ventricles. In first-degree AV block, the delay causes a prolonged P-R interval, which is consistent with the 0.35 seconds observed. This dysrhythmia is characterized by a consistent delay but all atrial impulses are conducted to the ventricles.
B: Complete heart block would show a lack of association between P waves and QRS complexes, with no relationship between atrial and ventricular activity.
C: Premature atrial complexes are early electrical impulses originating in the atria, resulting in abnormal P waves and irregular rhythm, not a constant P-R interval.
D: Atrial fibrillation is characterized by chaotic electrical activity in the atria, leading to an irregularly irregular ventricular response, not a constant P-R interval.
Question 5 of 5
A case manager is meeting with a client who asks about using alternative therapies to manage her rheumatoid arthritis. Which of the following statements should the nurse make?
Correct Answer: A
Rationale:
Correct
Answer: A
Rationale: Option A is the correct choice because it acknowledges the client's interest in alternative therapies and offers to review information to help select a safe practitioner. This response shows support for the client's autonomy and involves them in the decision-making process. It also ensures the client's safety by emphasizing the importance of selecting a reputable practitioner.
Incorrect
Choices:
B: This choice assumes the provider will automatically inform the client about therapies, which may not always be the case. It does not actively involve the client in their care.
C: While it supports the client's autonomy, it lacks guidance on selecting a safe practitioner and may not prioritize the client's safety.
D: Suggesting online support groups for remedies may not ensure the safety or efficacy of the therapies, and it does not involve professional guidance.