ATI RN
Introduction to Nursing Questions
Question 1 of 5
A clinic nurse is teaching a client prior to surgery. The client does not seem to comprehend the teaching, forgets a lot of what is said, and asks the same questions again and again. What action by the nurse is best?
Correct Answer: A
Rationale: The correct answer is A: Assess the client for anxiety. The client's lack of comprehension, forgetfulness, and repetitive questioning are indicative of potential anxiety affecting their ability to process information. By assessing for anxiety, the nurse can address the underlying issue and provide appropriate support. Breaking information into smaller bits (B) may help but doesn't address the root cause. Giving written information (C) may not be effective if the client is experiencing anxiety. Simply reviewing the information again (D) without addressing the anxiety may not improve the client's understanding.
Question 2 of 5
The nurse is reviewing drug therapy for hypertension. According to the JNC-8 guidelines, antihypertensive drug therapy for a newly diagnosed hypertensive African-American patient would most likely include which drug or drug classes?
Correct Answer: C
Rationale: The correct answer is C: Calcium channel blockers with thiazide diuretics. According to JNC-8 guidelines, for African-American patients with hypertension, initial drug therapy should include calcium channel blockers or thiazide diuretics due to their proven efficacy in this population. Calcium channel blockers help relax blood vessels and improve blood flow, while thiazide diuretics help reduce fluid volume and blood pressure. This combination has shown better outcomes and reduced risk of adverse effects in African-American patients. Incorrect choices: A: Vasodilators alone - Not recommended as initial therapy for newly diagnosed hypertensive African-American patients. B: ACE inhibitors alone - While ACE inhibitors are effective in treating hypertension, they are not the first-line choice for African-American patients based on JNC-8 guidelines. D: Beta blockers with thiazide diuretics - Beta blockers are not the preferred initial therapy for hypertensive African-American patients according to JNC-8 guidelines.
Question 3 of 5
A patient with aortic stenosis has acute pain due to decreased coronary blood flow. What would be an appropriate nursing intervention for this patient?
Correct Answer: A
Rationale: Correct Answer: A: Promote rest to decrease myocardial oxygen demand. Rationale: 1. Aortic stenosis leads to decreased coronary blood flow, causing myocardial ischemia and pain. 2. Rest decreases myocardial oxygen demand, reducing the workload on the heart. 3. By promoting rest, the body's oxygen demand decreases, helping to alleviate the acute pain. 4. Teaching about anticoagulant therapy (B) and nitroglycerin use (C) are not directly related to addressing decreased coronary blood flow. 5. Raising the head of the bed (D) to decrease venous return would not directly address the underlying issue of decreased coronary blood flow and acute pain.
Question 4 of 5
The nurse is caring for a patient who has a massive burn injury and possible hypovolemia. Which assessment data should be of most concern to the nurse?
Correct Answer: B
Rationale: The correct answer is B: Blood pressure is 90/40 mm Hg. This is the most concerning assessment data because it indicates hypotension, which can be a sign of hypovolemic shock in a patient with massive burn injury. Hypotension can lead to inadequate tissue perfusion and organ failure. Choice A is not as concerning as low urine output can be expected in a hypovolemic patient. Choice C is not as critical as oral fluid intake may vary, but IV fluids can be administered if needed. Choice D, skin tenting, is a sign of dehydration but is not as immediately life-threatening as hypotension.
Question 5 of 5
A nurse assesses several clients who have a history of respiratory disorders. Which client would the nurse assess first?
Correct Answer: D
Rationale: The correct answer is D. The nurse should assess the 27-year-old client with a heart rate of 120 beats/min first as an elevated heart rate can indicate respiratory distress or other serious underlying conditions. This assessment is crucial for immediate intervention. A: A 66-year-old client with a barrel chest and clubbed fingernails may indicate chronic obstructive pulmonary disease but does not require immediate attention compared to a high heart rate. B: A 48-year-old client with an oxygen saturation level of 92% at rest indicates potential hypoxemia but does not pose an immediate threat as the client is at rest. C: A 35-year-old client reporting orthopnea indicates difficulty breathing when lying flat, which is concerning but less urgent compared to a high heart rate.