ATI RN
Nursing a Concept Based Approach to Learning Test Bank Free Questions
Question 1 of 9
A client diagnosed with a stroke is going to receive treatment with fibrinolytic therapy using the recombinant tissue plasminogen activator alteplase (rt-PA). Which information should the nurse include when performing medication teaching for the client's family?
Correct Answer: D
Rationale: When performing medication teaching for the client's family about fibrinolytic therapy with alteplase (rt-PA), the nurse should include information that this medication is administered to break up existing clots and increase cerebral blood flow. rt-PA works by converting plasminogen to plasmin, which helps dissolve clots and restore blood flow to the brain. It is used specifically for ischemic strokes, not hemorrhagic strokes, and is most effective when administered within 3 hours (up to 4.5 hours in some cases) of the stroke symptoms starting. It is associated with potential serious complications, including an increased risk of bleeding, which the nurse should also educate the family about.
Question 2 of 9
The nurse is evaluating teaching provided to a client with peripheral vascular disease (PVD). Which client observation indicates teaching has been effective?
Correct Answer: B
Rationale: Option B, washing the lower extremities with mild soap, drying the legs, and applying a light moisturizer, indicates effective teaching for a client with peripheral vascular disease (PVD). Proper hygiene, including gentle washing with mild soap, thorough drying to prevent moisture-related skin breakdown, and moisturizing to prevent dry skin and promote circulation, are key components of self-care for individuals with PVD. Option A is incorrect because sitting with a pillow behind the knees does not specifically address PVD self-care. Option C is incorrect because crossing the left leg over the right while sitting does not relate to appropriate PVD management. Option D is incorrect because smoking in any form is detrimental to vascular health and should be discouraged in PVD management.
Question 3 of 9
A client diagnosed with a stroke is going to receive treatment with fibrinolytic therapy using the recombinant tissue plasminogen activator alteplase (rt-PA). Which information should the nurse include when performing medication teaching for the client's family?
Correct Answer: D
Rationale: When performing medication teaching for the client's family about fibrinolytic therapy with alteplase (rt-PA), the nurse should include information that this medication is administered to break up existing clots and increase cerebral blood flow. rt-PA works by converting plasminogen to plasmin, which helps dissolve clots and restore blood flow to the brain. It is used specifically for ischemic strokes, not hemorrhagic strokes, and is most effective when administered within 3 hours (up to 4.5 hours in some cases) of the stroke symptoms starting. It is associated with potential serious complications, including an increased risk of bleeding, which the nurse should also educate the family about.
Question 4 of 9
What is a good way for a nurse to prepare the environment for teaching?
Correct Answer: C
Rationale: Evaluating client abilities to perform skills with return demonstrations is a good way for a nurse to prepare the environment for teaching. By observing the clients' abilities to perform the necessary skills, the nurse can tailor the teaching to meet the specific needs of each individual. Return demonstrations allow for immediate feedback and correction if needed, ensuring that the clients understand and can perform the skills accurately. This interactive approach to teaching promotes active learning and enhances retention of information.
Question 5 of 9
During an assessment, the nurse asks the patient to move an extremity away from the body midline. What movement is the nurse assessing?
Correct Answer: C
Rationale: When the nurse asks the patient to move an extremity away from the body midline, they are assessing the movement of abduction. Abduction refers to the movement of a body part away from the midline of the body. In this case, moving the extremity away from the body midline represents abduction, as the limb is being moved outward or away from the center of the body. Flexion and extension involve bending and straightening movements, respectively, along a joint axis, while adduction involves moving a body part towards the midline of the body.
Question 6 of 9
A perimenopausal patient is experiencing frequency, urgency, nocturia, dysuria, and cloudy, rust- colored urine for the third time in the past 2 years. What should the nurse include when teaching this patient? Select all that apply.
Correct Answer: B
Rationale: B. Recommendations for perineal cleansing: Proper perineal hygiene is important in preventing urinary tract infections (UTIs). Teaching the patient to cleanse the perineal area properly can help reduce the risk of UTIs.
Question 7 of 9
The nurse is caring for a child who has just been diagnosed with an atrial septal defect (ASD). Which manifestations would the nurse expect upon assessment? Select all that apply.
Correct Answer: B
Rationale: Atrial septal defect (ASD) is a congenital heart defect where there is an abnormal opening between the atria of the heart. The manifestations of ASD can vary depending on the size of the defect and the individual. However, common manifestations may include:
Question 8 of 9
A client diagnosed with cardiomyopathy reports having to rest between activities during the day. The client asks the nurse why this is occurring. Which reason should the nurse include in the response to the client?
Correct Answer: B
Rationale: The client with cardiomyopathy may experience decreased cardiac output, which is a common manifestation of this condition. Cardiomyopathy is a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body. Reduced cardiac output means that less blood is being pumped out by the heart with each beat, leading to symptoms such as fatigue, weakness, and the need to rest between activities. This is why the client is experiencing the need to rest between activities during the day.
Question 9 of 9
The nurse is preparing teaching for a patient with mild osteoarthritis of the knees. Which medication treatments should the nurse include in these instructions? Select all that apply.
Correct Answer: B
Rationale: A. Opioids are not typically indicated for mild osteoarthritis of the knees. They are usually reserved for more severe cases or when other pain management options have failed due to the potential for addiction and side effects.