ATI RN
Introduction to Nursing Pdf Questions
Question 1 of 5
A nurse cares for a client who had a chest tube placed 6 hours ago and refuses to take deep breaths because of the pain. What action would the nurse take?
Correct Answer: D
Rationale: The correct answer is D because administering pain medication will help alleviate the client's discomfort, enabling them to take deep breaths essential for lung expansion following chest tube placement. Deep breathing prevents complications like atelectasis. Option A is incorrect as ambulation may be painful. Option B does not address the client's pain issue. Option C is wrong because shallow breaths can lead to lung complications.
Question 2 of 5
A home health nurse is visiting a new client who uses oxygen in the home. For which factors does the nurse assess when determining if the client is using the oxygen safely? (Select all that do not apply.)
Correct Answer: D
Rationale: The correct answer is D because fluorescent light bulbs can pose a fire hazard when used near oxygen due to their high energy output. Oxygen supports combustion, and fluorescent bulbs can generate heat and sparks. A, B, and C are incorrect because they are factors that the nurse should assess for safe oxygen use in the home. Smoking prohibition prevents fire risks, functional electrical cords prevent electrical hazards, and storing flammable liquids away from oxygen reduces the risk of explosions.
Question 3 of 5
After 2 months of tuberculosis (TB) treatment with isoniazid, rifampin (Rifadin), pyrazinamide, and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next?
Correct Answer: C
Rationale: The correct answer is C: Ask the patient whether medications have been taken as directed. This is the next appropriate action because the patient is still testing positive for AFB despite being on the appropriate TB treatment regimen for 2 months. By assessing medication adherence, the nurse can determine if the lack of improvement is due to non-compliance. If the patient has been taking the medications as prescribed, then further evaluation for drug-resistant TB or other factors may be necessary. Choice A is incorrect because assuming drug resistance without confirming adherence could lead to unnecessary treatment changes. Choice B is not the immediate priority as ensuring medication adherence should come first. Choice D is premature without first confirming adherence and evaluating other possible reasons for treatment failure.
Question 4 of 5
A patient who has heart failure has recently started taking digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril. Which finding by the home health nurse is a priority to communicate to the health care provider?
Correct Answer: C
Rationale: The correct answer is C. A serum potassium level of 3.0 mEq/L after 1 week of therapy is a priority finding to communicate to the healthcare provider because digoxin, furosemide, and captopril can all cause electrolyte imbalances, especially hypokalemia, which can increase the risk of digoxin toxicity leading to life-threatening dysrhythmias. It is crucial to address and monitor potassium levels closely in patients taking these medications. A: Presence of 1+ to 2+ edema in the feet and ankles is a common finding in heart failure patients and may not be an immediate concern unless it worsens. B: Palpable liver edge 2 cm below the ribs may indicate hepatic congestion, which can occur in heart failure, but it is not as urgent as monitoring potassium levels. D: A weight increase of 2 pounds over 3 days can be a sign of fluid retention, which is important to monitor but
Question 5 of 5
A patient with metastatic colon cancer has severe vomiting after each administration of chemotherapy. Which action by the nurse is appropriate?
Correct Answer: C
Rationale: The correct answer is C: Administer prescribed antiemetics 1 hour before the treatments. This is appropriate because antiemetics are medications specifically designed to prevent or reduce nausea and vomiting. By administering antiemetics before chemotherapy, the nurse can help prevent severe vomiting in the patient. Option A is incorrect as large meals may worsen nausea. Option B may not be sufficient for severe vomiting. Option D is incorrect as citrus beverages may aggravate nausea. Administering antiemetics before chemotherapy is the most effective way to manage severe vomiting in this scenario.