ATI RN
Introduction to Nursing Questions
Question 1 of 5
A client has a nursing diagnosis of Risk for injury related to adverse effects of potassium-wasting diuretics. What is a correctly written client outcome for this nursing diagnosis?
Correct Answer: A
Rationale: The correct answer is A because it directly addresses the nursing diagnosis by focusing on the client's ability to identify potassium-rich food sources, which is crucial in managing the risk for injury related to potassium-wasting diuretics. The outcome is specific, measurable, and achievable, aligning with the SMART criteria for goal setting. Choice B is incorrect as it does not specify a measurable action related to potassium-rich foods. Choice C lacks the specificity of identifying the number of potassium-rich food sources. Choice D is incorrect as it does not directly address the nursing diagnosis and focuses on a different aspect of the client's understanding.
Question 2 of 5
A client's wound is draining thick yellow material. The nurse correctly describes the drainage as:
Correct Answer: D
Rationale: The correct answer is D: Purulent. This is because thick yellow drainage indicates the presence of pus, which is characteristic of purulent drainage. Pus consists of dead white blood cells, tissue debris, and bacteria, signifying infection. Sanguineous drainage is fresh red blood, serous-sanguineous is a mix of clear and red drainage, and serous is clear and watery. Therefore, in this case, purulent is the most appropriate description of the drainage.
Question 3 of 5
After a few hours in the emergency room, the client is admitted to the ward with an order of hourly monitoring of BP. The nurse finds that the cuff is too narrow and this will cause the BP reading to be:
Correct Answer: B
Rationale: The correct answer is B: Higher than what the reading should be. A narrow cuff will result in inaccurate BP readings because it can cause increased pressure on the artery, leading to artificially elevated readings. When the cuff is too narrow, it can compress the artery more than necessary, resulting in a higher BP reading. This is why it is important to use the correct cuff size based on the client's arm circumference to obtain an accurate reading. Choices A and C are incorrect because a narrow cuff would not result in a lower or the same BP reading, respectively. Choice D, inconsistent, is also incorrect because the incorrect cuff size will consistently produce higher readings due to increased pressure on the artery.
Question 4 of 5
While caring for a client, the nurse notes a pulsating mass in the client's periumbilical area. Which of the following assessments is appropriate for the nurse to perform?
Correct Answer: B
Rationale: The correct answer is B: Auscultate the mass. Auscultation can help identify the nature of the pulsating mass, such as detecting bruits, which may indicate an underlying vascular issue. Measuring the length (A) is not relevant for assessing a pulsating mass. Percussion (C) is used to assess underlying structures, not the nature of a mass. Palpation (D) can provide information on the size, shape, and consistency of the mass but auscultation is essential to detect potential abnormalities like bruits.
Question 5 of 5
The best position for a client for thoracentesis is:
Correct Answer: A
Rationale: The correct answer is A: Upright leaning sideward. This position allows for better access to the pleural space between the ribs, minimizing the risk of injury to surrounding structures. The upright position helps to expand the lung and diaphragm, making it easier to locate the fluid pocket for thoracentesis. Leaning sideways helps to ensure gravity assists in pooling the fluid away from the needle insertion site. Choice B: Orthopneic is not the best position for thoracentesis as the patient is sitting upright and leaning forward, which may not be as effective in accessing the fluid pocket. Choice C: Prone position is incorrect because the patient is lying face down, making it difficult to access the pleural space in the back. Choice D: Supine position is also incorrect as the patient is lying flat on their back, making it challenging to access the pleural space effectively.