ATI RN
Provide Basic Patient Care Following Direction of Nursing Staff Questions
Question 1 of 5
A client in a long term care facility complains of pain. The nurse collects data about the client's pain. The first step in pain assessment is for the nurse to
Correct Answer: C
Rationale: Although all of the options above are correct, the first and most important piece of information in this client's pain assessment is what the client is telling you about the pain - 'the client's report.'
Question 2 of 5
A 32-year-old woman sustains an injury to the left recurrent laryngeal nerve during thyroidectomy. Which of the following postoperative findings is MOST likely in this patient?
Correct Answer: A
Rationale: Injury to the recurrent laryngeal nerve paralyzes the left vocal cord, causing it to adduct at rest due to loss of abductor function, risking hoarseness.
Question 3 of 5
The nurse has completed a preoperative assessment for a patient going to surgery and gathers assessment data. Which will be the most important next step for the nurse to take?
Correct Answer: A
Rationale: The correct answer is A because notifying the operating suite of the patient's latex allergy is crucial to prevent potential allergic reactions during surgery. This step ensures patient safety and proper care. Option B is irrelevant to the patient's immediate preoperative care. Option C is important but not the most critical at this moment. Option D is not appropriate as vital signs should be obtained by the nurse herself.
Question 4 of 5
You are called to assist a pregnant female in the 24th week gestation period according to her due date. The pale 26-year-old patient is found supine in bed, complaining of dizziness/weakness with extreme nausea. The patient denies vaginal bleeding, amniotic fluid leakage, or abdominal pain. There are no signs of imminent birth or active labor. She reports receiving normal prenatal care with no associated problems found during the pregnancy. Her heart rate is 126-130 beats per minute; her blood pressure is 80 mmHg systolic while her skin is cool and pale. Which of the following conditions is most likely to cause the patient's presentation?
Correct Answer: C
Rationale: The correct answer is C: Supine hypotension. In pregnant women, lying supine can compress the inferior vena cava, reducing venous return and cardiac output, leading to hypotension and symptoms like dizziness, weakness, and nausea. This condition is called supine hypotension syndrome. The patient's symptoms of dizziness and weakness, along with the low blood pressure and cool, pale skin, are indicative of inadequate blood flow due to supine positioning. Choices A, B, and D are incorrect because they do not align with the patient's symptoms and presentation. Uterine rupture, spontaneous abortion, and placenta previa typically present with different signs and symptoms, such as abdominal pain, vaginal bleeding, and fetal distress, which are absent in this case.
Question 5 of 5
You are ordered to administer 3 mg/min of lidocaine via intravenous infusion to your cardiac patient who presents with a heart rate greater than 130 beats per minute as well as greater than 10 multifocal PVCs every minute. Therefore, you quickly but carefully mix 2 grams of the medication in 500 mL of normal saline and attach micro-drip tubing to the solution bag. Which of the following drip rates would effectively deliver the ordered dose of lidocaine?
Correct Answer: B
Rationale: The correct answer is B: 30 gtts/min. To calculate the drip rate for an IV infusion, you need to use the formula: (Volume to be infused in mL) x (Drop factor of the tubing) / (Time in minutes). In this case, the volume to be infused is 500 mL, the drop factor is 60 gtt/mL (for micro-drip tubing), and the time is 1 minute. Therefore, (500 mL) x (60 gtt/mL) / (1 minute) = 30 gtts/min. This drip rate will effectively deliver the ordered dose of lidocaine at 3 mg/min. Choice A: 15 gtts/min is incorrect because it would deliver half of the ordered dose. Choice C: 60 gtts/min is incorrect because it would deliver double the ordered dose. Choice D: 45 gtts/min is incorrect because it does not match the calculated value for the required dose of 30 gt