ATI RN
health assessment test bank Questions
Question 1 of 9
A nurse is assessing a patient who is experiencing dizziness and weakness. The nurse should prioritize which of the following?
Correct Answer: A
Rationale: The correct answer is A: Blood pressure measurement. Dizziness and weakness can be symptoms of hypotension or low blood pressure. Prioritizing blood pressure measurement is crucial because it can indicate if the patient is at risk of complications like cardiovascular collapse. Pulse oximetry (B) is important for assessing oxygen levels in the blood but may not directly address dizziness and weakness. Blood glucose levels (C) are important but not the priority in this scenario. Cardiac monitoring (D) may be necessary but should come after assessing blood pressure to rule out immediate life-threatening conditions.
Question 2 of 9
Which client must avoid foods high in potassium?
Correct Answer: D
Rationale: The correct answer is D. A client with renal disease must avoid foods high in potassium to prevent hyperkalemia, as the kidneys are unable to properly filter and excrete potassium. Foods high in potassium can lead to dangerous levels of potassium in the blood, which can be life-threatening for individuals with renal disease. Choice A is incorrect because a client receiving diuretic therapy may actually need to increase their potassium intake due to the potassium-wasting effects of diuretics. Choice B is incorrect as having an ileostomy does not necessarily affect potassium levels. Choice C is incorrect because clients with metabolic alkalosis may actually benefit from consuming foods high in potassium to help correct the acid-base imbalance.
Question 3 of 9
A woman comes to the clinic complaining of severe itching on her lower legs. Upon examination, the nurse notices red, scaly patches on the skin. The nurse suspects that this is:
Correct Answer: A
Rationale: The correct answer is A: Psoriasis. Psoriasis is characterized by red, scaly patches on the skin, which align with the symptoms described. Psoriasis commonly affects the lower legs and is associated with severe itching. Eczema (choice B) is characterized by red, inflamed, and itchy skin patches, but typically presents differently from psoriasis. Contact dermatitis (choice C) is a localized reaction that occurs when the skin comes into contact with an irritant or allergen, and fungal infections (choice D) typically present with itching, redness, and sometimes peeling skin, but not necessarily scaly patches like psoriasis.
Question 4 of 9
A patient is at the clinic to have her blood pressure checkeShe has been coming to the clinic weekly since her medications were changed 2 months ago. The nurse should:
Correct Answer: A
Rationale: Rationale: 1. Collecting a follow-up database ensures up-to-date information. 2. It allows for monitoring of medication effectiveness and any new symptoms. 3. Checking the blood pressure is essential but needs current context. 4. Asking the patient to read her record may not provide all necessary updates. 5. The complete health history is crucial but obtaining it first may delay urgent blood pressure check.
Question 5 of 9
A nurse is caring for a patient who is post-operative following an abdominal surgery. The nurse should prioritize which of the following interventions?
Correct Answer: A
Rationale: The correct answer is A: Encouraging early ambulation to prevent deep vein thrombosis. Early ambulation helps prevent blood clot formation in the legs, reducing the risk of deep vein thrombosis post-surgery. It also promotes circulation and aids in preventing complications like pneumonia. Administering pain medication (B) is important, but preventing complications should take priority. Providing wound care (C) is essential but not the top priority. Encouraging a high-protein diet (D) is beneficial for healing, but immediate post-operative mobility is crucial for preventing complications.
Question 6 of 9
What is the most important assessment for a client who has been receiving chemotherapy for several weeks?
Correct Answer: A
Rationale: The correct answer is A: Check for signs of infection. This is crucial because chemotherapy weakens the immune system, increasing the risk of infections. Signs of infection such as fever, chills, sore throat, and cough should be closely monitored to prevent serious complications. Monitoring weight (B) and nutrition (C) are important but not as critical as detecting infections promptly. Checking for skin changes (D) is also important, but it is secondary to identifying and managing infections due to the immediate threat they pose to the client's health.
Question 7 of 9
Which condition places a client at risk for elevated ammonia levels?
Correct Answer: D
Rationale: The correct answer is D: Lupus. Lupus can affect the kidneys, leading to renal impairment. Renal impairment can decrease the body's ability to excrete ammonia, resulting in elevated levels. Renal failure (choice A) can also lead to elevated ammonia levels, but lupus specifically contributes to renal issues. Cirrhosis (choice B) primarily affects the liver, not kidneys. Psoriasis (choice C) is a skin condition and does not directly impact ammonia levels.
Question 8 of 9
Acyclovir is the drug of choice for which condition?
Correct Answer: B
Rationale: Acyclovir is a nucleoside analog antiviral drug that is specifically effective against herpes simplex virus (HSV) types 1 and 2, as well as varicella-zoster virus (VZV). The drug works by inhibiting viral DNA synthesis. HSV and VZV are both members of the herpes virus family, and acyclovir is most commonly prescribed for infections caused by these viruses. Therefore, the correct answer is B. Choice A (HIV) is incorrect because acyclovir is not effective against HIV. Choice C (CMV) is incorrect because acyclovir is less effective against cytomegalovirus (CMV) compared to HSV and VZV. Choice D (influenza A viruses) is incorrect because acyclovir is not indicated for the treatment of influenza viruses.
Question 9 of 9
What term describes excessive stretching of a ligament, as seen in a client with a pulled ligament?
Correct Answer: B
Rationale: The correct answer is B: strain. A strain refers to excessive stretching or tearing of a muscle or tendon, not a ligament. A sprain (choice A) is the correct term for excessive stretching of a ligament. Subluxation (choice C) refers to partial dislocation of a joint, not a ligament injury. Distortion (choice D) is a general term that does not specifically describe ligament stretching. Therefore, the correct term for excessive stretching of a ligament is a sprain, making choice A the correct answer.