ATI LPN
Fundamentals of Nursing: The Art and Science of Person-Centered Care Tenth, North American Edition
Chapter 29 : Complementary and Integrative Health Questions
Question 1 of 5
The nurse is working the night shift on a surgical unit and notices that the patient's temperature is 96.8?°F (36?°C), whereas at 4:00 PM the preceding day, it was 98.6?°F (37?°C). What should the nurse do?
Correct Answer: D
Rationale: A temperature of 96.8?°F (36?°
C) is slightly low but within normal diurnal variation (lowest at night). Waiting 30 minutes to recheck (
D) confirms if it's a trend or artifact, avoiding overreaction. Calling the provider (
A) is premature for a non-critical value without symptoms. Lowering it further (
B) is illogical for hypothermia. Adding a blanket (
C) assumes hypothermia without confirmation.
Choice D is correct, reflecting nursing judgment to monitor trends, aligning with circadian temperature dips and post-surgical assessment protocols.
Question 2 of 5
A patient is experiencing pyrexia. Which piece of equipment will the nurse obtain to monitor this condition?
Correct Answer: B
Rationale: Pyrexia (fever) requires temperature monitoring, making a thermometer (
B) essential. A stethoscope (
A) assesses heart/lung sounds, not temperature. A blood pressure cuff (
C) or sphygmomanometer (
D) measures pressure, not fever.
Choice B is correct as thermometers directly track temperature changes, a fundamental tool in nursing to manage and document febrile states accurately.
Question 3 of 5
Which statement correctly defines hyperthermia?
Correct Answer: C
Rationale: Hyperthermia is an uncontrolled rise in body temperature when heat production exceeds dissipation (
C), often from external factors or exertion, not set-point shifts. A downward set-point shift (
A) isn't hyperthermia. An upward shift (
B) defines fever, not hyperthermia. Reduced mechanisms (
D) may contribute but isn't the definition.
Choice C is correct, distinguishing hyperthermia from fever per nursing pathophysiology, critical for appropriate interventions.
Question 4 of 5
The patient with heart failure is restless with a temperature of 102.2?°F (39?°C). Which action will the nurse take?
Correct Answer: A
Rationale: Heart failure with fever (102.2?°F) and restlessness suggests increased oxygen demand. Applying oxygen (
A) addresses potential hypoxemia, a priority in heart failure exacerbation. Coughing (
B) is irrelevant without respiratory symptoms. Restricting fluids (
C) may worsen dehydration in fever. Increasing metabolic rate (
D) exacerbates stress.
Choice A is correct, aligning with nursing priorities to support oxygenation in cardiac patients with fever-induced strain.
Question 5 of 5
What is the primary purpose of pulse assessment?
Correct Answer: C
Rationale: Pulse assessment primarily evaluates cardiac status (
C), reflecting heart rate and rhythm, key indicators of cardiovascular function. Blood pressure (
A) relates but requires a cuff. Temperature (
B) isn't pulse-related. Respiratory status (
D) is secondary.
Choice C is correct, per nursing fundamentals, as pulse directly monitors heart performance, guiding cardiac care.