ATI RN
Nursing a Concept Based Approach to Learning Test Bank Questions
Question 1 of 9
A female patient who was treated 3 months ago for a urinary tract infection is experiencing the same symptoms now. What should the nurse ask the patient during the health assessment?
Correct Answer: D
Rationale: The nurse should ask the patient if she completed the antibiotic prescribed for the first urinary tract infection because it is important to determine if the initial infection was fully treated. If the antibiotic course was not completed as prescribed, it could lead to a recurrence of the infection due to incomplete eradication of the bacteria. Additionally, incomplete treatment can lead to antibiotic resistance, making it harder to treat future infections. Understanding if the patient followed through with the prescribed treatment is crucial in assessing the current situation and planning appropriate interventions.
Question 2 of 9
A patient with osteoporosis is prescribed the bisphosphonate alendronate (Fosamax). What should the nurse include when teaching the patient about this medication? Select all that apply.
Correct Answer: A
Rationale: A. Take the medication as directed with clear water only: Alendronate should be taken with a full glass of plain water on an empty stomach in the morning at least 30 minutes before consuming any food, drink, or other medications. Avoid taking it with any other liquids besides plain water, as other beverages can interfere with the absorption of the drug.
Question 3 of 9
The nurse is planning care for a newly admitted client diagnosed with pulmonary embolism (PE). The nurse anticipates the client will need anticoagulant therapy. What is true regarding this therapy for the treatment of this condition?
Correct Answer: D
Rationale: Anticoagulant therapy, specifically heparin, is commonly used as the initial treatment for pulmonary embolism (PE) because it inhibits the formation of additional clots by altering the synthesis of vitamin K-dependent clotting factors. Heparin works quickly and can be administered intravenously to rapidly prevent the clot from growing in size. Warfarin, another anticoagulant, is generally started after heparin therapy is initiated to provide long-term anticoagulation. Major hemorrhage is a potential side effect of anticoagulant therapy, but it is not considered common. The initiation of heparin and warfarin (Coumadin) at the same time is not standard practice due to the differing mechanisms of action and monitoring required for each medication. Anticoagulant therapy is considered first-line treatment for PE, not second-line.
Question 4 of 9
The nurse is planning care for a client with peripheral vascular disease (PVD) who is at risk for Impaired Skin Integrity. Which intervention is appropriate for the nurse to include in the plan of care?
Correct Answer: B
Rationale: For a client with peripheral vascular disease (PVD) who is at risk for Impaired Skin Integrity, keeping the skin clean and dry, and moisturizing areas of dryness is crucial. Patients with PVD often have compromised circulation to the extremities, which can lead to decreased oxygen and nutrient delivery to tissues, increasing the risk of skin breakdown and impaired wound healing. Proper skin care helps prevent skin breakdown, decreases the risk of infection, and promotes overall skin health. Keeping the skin clean and dry helps prevent skin breakdown, while moisturizing areas of dryness helps maintain skin integrity. This intervention focuses on maintaining skin health and preventing complications associated with compromised circulation in patients with PVD.
Question 5 of 9
A patient has been experiencing diarrhea for the past week. What should the nurse do first when caring for this patient?
Correct Answer: A
Rationale: The first action that the nurse should take when caring for a patient experiencing diarrhea is to ask the patient to describe the number and character of daily stools. This assessment is crucial in determining the severity and possible cause of the diarrhea. By understanding the frequency and consistency of the stools, the nurse can evaluate if the diarrhea is due to an infection, a reaction to medications, dietary factors, or other underlying health issues. Based on this assessment, appropriate interventions can then be implemented, which may include further diagnostic tests, fluid replacement therapy, dietary modifications, or medication administration. It is essential to gather this information first before considering other interventions such as abstaining from oral intake or using over-the-counter antidiarrheal medications.
Question 6 of 9
The nurse is planning care for a client admitted with a stroke. Which intervention would support the client's sensorimotor needs?
Correct Answer: A
Rationale: Supporting a stroke client's sensorimotor needs involves encouraging independence and rehabilitation of the affected side. By encouraging the use of the nonaffected arm for self-care activities like feeding, bathing, and dressing, the nurse is promoting sensorimotor development and function in the affected arm. This intervention will help the client regain strength, coordination, and functionality in the affected arm, which is crucial for their overall recovery and independence. Encouraging the client to actively engage the affected arm promotes neuroplasticity and can improve motor function over time.
Question 7 of 9
The nurse is caring for a patient with an epiphyseal fracture. What bone classification should the nurse keep in mind when planning this patient’s care?
Correct Answer: B
Rationale: An epiphyseal fracture involves the distal or proximal epiphysis of a long bone, such as the femur, tibia, or humerus. Long bones are characterized by having a long shaft with distinct ends (epiphyses). The epiphysis is the site of bone growth and plays a crucial role in bone development. Therefore, understanding the classification of the bone as long helps the nurse in providing appropriate care for the patient with an epiphyseal fracture, such as monitoring growth plate involvement and ensuring proper immobilization for healing.
Question 8 of 9
The nurse is caring for a client who has not been adhering to treatment with anti-hypertension medication. Which approach to addressing this issue should the nurse use?
Correct Answer: B
Rationale: When addressing a client's non-adherence to treatment, a nonjudgmental approach is most effective. This involves showing empathy, understanding, and support without criticizing or condemning the client. By adopting a nonjudgmental attitude, the nurse can create a safe environment for open communication and collaboration to explore the reasons behind the client's non-adherence. This approach helps build trust and rapport, which are essential for promoting positive behavior change and improving treatment adherence. In contrast, being indifferent, demanding, or confrontational can lead to defensiveness, resistance, and further non-adherence in the client.
Question 9 of 9
A pregnant client is diagnosed with HELLP syndrome. Based on this diagnosis, which laboratory findings are consistent with diagnosis of HELLP?
Correct Answer: B
Rationale: HELLP syndrome is a serious complication of pregnancy characterized by Hemolysis (H), Elevated Liver enzymes (EL), and a Low Platelet count (LP). Therefore, the correct laboratory finding consistent with the diagnosis of HELLP syndrome is hemolysis. This can be indicated by an elevated lactate dehydrogenase (LDH) level, low haptoglobin, elevated bilirubin, and the presence of schistocytes on a blood smear. The other options (A, C, and D) do not align with the classic presentation of HELLP syndrome.