ATI RN
jarvis physical examination and health assessment 9th edition test bank Questions
Question 1 of 9
A nurse is caring for a patient with chronic kidney disease. The nurse should monitor for which of the following signs of fluid overload?
Correct Answer: A
Rationale: The correct answer is A, shortness of breath and weight gain, because fluid overload in patients with chronic kidney disease can lead to pulmonary edema and weight gain due to retained fluid. Shortness of breath occurs as the excess fluid accumulates in the lungs. Increased urine output and fatigue (B) are more indicative of dehydration. Dizziness and hypotension (C) are symptoms of hypovolemia, not fluid overload. Nausea and vomiting (D) are nonspecific symptoms and not typically associated with fluid overload.
Question 2 of 9
A family who immigrated to Canada 3 months ago has come to the clinic to see the nurse practitioner. One of the parents has found work, but not in his fielThe other parent has not been able to find a joThis family of five is living in a one-bedroom apartment. The nurse practitioner is aware that the health of new immigrants is:
Correct Answer: A
Rationale: Step 1: New immigrants face many challenges such as language barriers, cultural differences, lack of social support, and limited access to healthcare. Step 2: These factors can negatively impact their health by causing stress, mental health issues, and difficulties in accessing healthcare services. Step 3: Employment and stable housing are important factors for immigrants' health, but they alone may not address the broader issues affecting their well-being. Step 4: Therefore, the correct answer is A, as the health of new immigrants is indeed negatively affected by a combination of contributing factors beyond just employment and housing.
Question 3 of 9
A nurse is caring for a patient with a history of hypertension. The nurse should educate the patient to prioritize which of the following?
Correct Answer: A
Rationale: The correct answer is A: Limiting sodium intake. This is crucial for a patient with hypertension as excess sodium can lead to increased blood pressure. Sodium intake should be limited to lower the risk of cardiovascular complications. B: Increasing potassium intake is beneficial, but not as critical as limiting sodium for hypertension management. C: Increasing fluid intake may or may not be necessary depending on the patient's condition, but it is not as crucial as limiting sodium for hypertension management. D: Consuming more caffeine can actually elevate blood pressure, so it is not recommended for patients with hypertension.
Question 4 of 9
A nurse is teaching a patient with diabetes about self-management. Which of the following statements by the patient indicates proper understanding?
Correct Answer: A
Rationale: The correct answer is A because monitoring blood glucose levels regularly is essential for managing diabetes effectively. By monitoring blood glucose levels, the patient can make informed decisions about medication, diet, and exercise. This helps in preventing complications and maintaining blood sugar levels within the target range. Choice B is incorrect because stopping insulin when blood sugar is within the normal range can lead to fluctuations and potential hyperglycemia. Choice C is a good practice but does not specifically address blood sugar management. Choice D is also important but does not encompass all aspects of diabetes management.
Question 5 of 9
A nurse is caring for a patient who is post-operative following abdominal surgery. The nurse should prioritize which of the following to prevent complications?
Correct Answer: A
Rationale: Correct Answer: A - Encouraging early ambulation Rationale: 1. Early ambulation helps prevent post-operative complications like blood clots and pneumonia. 2. Movement promotes circulation, aids in lung expansion, and prevents muscle atrophy. 3. It also supports bowel function and helps prevent constipation, a common post-operative issue. 4. Ambulation aids in overall recovery and reduces the risk of complications associated with prolonged immobility. Other Choices: B: Administering pain medication - Important for comfort but not the top priority for preventing complications. C: Providing wound care and dressing changes - Necessary for wound healing but not the immediate priority to prevent complications. D: Monitoring for signs of infection - Critical but not the primary intervention to prevent complications immediately post-op.
Question 6 of 9
A female nurse is interviewing a male patient who is close in age to the nurse. During the interview, the patient makes an overtly sexual comment. The nurse's best response would be:
Correct Answer: D
Rationale: The correct answer is D because it directly addresses the inappropriate behavior, sets a boundary, and communicates the nurse's discomfort in a professional manner. By stating that the comment makes them uncomfortable and asking the patient to refrain from such behavior, the nurse asserts their professionalism while maintaining respect for both parties. Choice A is too abrupt and may escalate the situation. Choice B dismisses the behavior, which is inappropriate. Choice C could be perceived as confrontational and potentially lead to a defensive response from the patient.
Question 7 of 9
The nurse is planning health education for a 65-year-old woman who has had a cerebrovascular accident (stroke) and is aphasic. Which of the following is most important to use when assessing mental health in this situation?
Correct Answer: C
Rationale: The correct answer is C: Please point to articles in the room and parts of the body as I name them. This is the most important assessment for mental health in an aphasic patient post-stroke because it evaluates their comprehension, communication abilities, and cognitive function. Pointing to articles and body parts demonstrates understanding and ability to follow instructions, which are crucial aspects of mental health assessment in this context. A: Please count back from 100 by sevens - This choice involves memory and mathematical abilities, which may not accurately assess mental health in an aphasic patient. B: I will name three items and ask you to repeat them in a few minutes - This choice tests memory recall, which is not as relevant for assessing mental health in an aphasic patient post-stroke. D: What would you do if you found a stamped, addressed envelope on the sidewalk? - This choice assesses problem-solving skills, which may not be the most appropriate indicator of mental health in an aphasic patient.
Question 8 of 9
A nurse is caring for a patient who has a history of hypertension and reports a new onset of headaches, nausea, and dizziness. The nurse should be most concerned about which of the following?
Correct Answer: A
Rationale: The correct answer is A: Hypertensive crisis. The nurse should be most concerned about this option because the patient has a history of hypertension and is experiencing new onset symptoms such as headaches, nausea, and dizziness, which could indicate a sudden and severe increase in blood pressure. This condition, if left untreated, can lead to serious complications such as stroke or heart attack. Summary: - B: Migraine headache is unlikely as the symptoms described are not typical of a migraine. - C: Benign positional vertigo is unlikely as it does not explain the presence of headaches and nausea. - D: Tension headache is less concerning compared to hypertensive crisis, given the patient's history of hypertension and the severity of symptoms.
Question 9 of 9
A nurse is caring for a patient with a history of diabetes. The nurse should monitor for which of the following complications?
Correct Answer: D
Rationale: The correct answer is D: Hyperglycemia. Patients with diabetes are at risk for high blood sugar levels, leading to hyperglycemia. This can result in various complications such as diabetic ketoacidosis or hyperosmolar hyperglycemic state. The nurse should monitor the patient's blood glucose levels regularly to prevent these serious complications. Explanation for incorrect choices: A: Hypoglycemia - While hypoglycemia is a concern for diabetic patients, hyperglycemia is a more common and immediate risk. B: Hyperkalemia - While hyperkalemia can occur in some diabetic patients, hyperglycemia is a more common and primary concern. C: Hypotension - While diabetic patients can experience hypotension, hyperglycemia poses a more immediate threat to their health.