ATI RN
foundation of nursing questions Questions
Question 1 of 9
A nurse is caring for a teenage girl who has had an anaphylactic reaction after a bee sting. The nurse is providing patient teaching prior to the patients discharge. In the event of an anaphylactic reaction, the nurse informs the patient that she should self-administer epinephrine in what site?
Correct Answer: B
Rationale: The correct answer is B: Thigh. When administering epinephrine during an anaphylactic reaction, the thigh is the recommended site due to its large muscle mass and quick absorption rate. Steps: 1. Remove safety cap. 2. Firmly push the auto-injector against the thigh until it clicks. 3. Hold in place for a few seconds. 4. Seek medical help immediately. Rationale for incorrect choices: A: Forearm - Not recommended due to smaller muscle mass and slower absorption. C: Deltoid muscle - Not preferred as it may not provide as rapid absorption as the thigh. D: Abdomen - Not ideal due to potential fat layers that could affect absorption speed.
Question 2 of 9
A woman calls the clinic and tells the nurse she has had bloody drainage from her right nipple. The nurse makes an appointment for this patient, expecting the physician or practitioner to order what diagnostic test on this patient?
Correct Answer: A
Rationale: The correct answer is A: Breast ultrasound. Bloody drainage from the nipple can be indicative of various conditions such as breast cancer. A breast ultrasound is a non-invasive imaging test that can help visualize any abnormalities in the breast tissue, including masses or tumors. It is commonly used to evaluate breast symptoms like nipple discharge. Radiography (B) is not typically used for evaluating breast conditions. Positron emission testing (PET) (C) is more commonly used in cancer staging and may not be the first-line test for this symptom. Galactography (D) is a specific imaging test used to evaluate the ducts of the breast and may not be the initial test for bloody nipple discharge.
Question 3 of 9
A nurse is planning the postoperative care of a patient who is scheduled for radical prostatectomy. What intraoperative position will place the patient at particular risk for the development of deep vein thrombosis postoperatively?
Correct Answer: D
Rationale: The correct answer is D: Lithotomy position. In lithotomy position, the patient's legs are elevated and positioned higher than the heart, which can lead to venous stasis and increase the risk of deep vein thrombosis (DVT). This position compresses the femoral veins, hindering blood flow and predisposing the patient to DVT formation. Summary: A: Fowlers position - Not typically associated with increased DVT risk. B: Prone position - Not typically associated with increased DVT risk. C: Supine position - Generally considered a safe position regarding DVT risk.
Question 4 of 9
A nurse is assessing a patient who presented to the ED with priapism. The student nurse is aware that this condition is classified as a urologic emergency because of the potential for what?
Correct Answer: C
Rationale: The correct answer is C: Permanent vascular damage. Priapism is a prolonged erection that can lead to ischemia and damage to the penile tissue due to impaired blood flow, potentially resulting in permanent vascular damage. Urinary tract infection (A) is unrelated to priapism. Chronic pain (B) may occur but is not the primary concern. Future erectile dysfunction (D) can result from priapism but is not as immediate or severe as permanent vascular damage. Therefore, C is the most critical consequence to address in priapism.
Question 5 of 9
A child has been transported to the emergency department (ED) after a severe allergic reaction. The ED nurse is evaluating the patients respiratory status. How should the nurse evaluate the patients respiratory status? Select all that apply.
Correct Answer: B
Rationale: Rationale: Assessing breath sounds is crucial in evaluating respiratory status as it helps identify any signs of airway obstruction or respiratory distress. This includes listening for wheezing, crackles, or diminished breath sounds. Lung function testing (A) may not be feasible in an acute emergency situation. Oxygen saturation (C) is important but does not provide a comprehensive assessment of respiratory status. Monitoring respiratory pattern (D) and assessing respiratory rate (E) are important but do not directly assess breath sounds, which are vital in identifying immediate respiratory issues.
Question 6 of 9
A 35-year-old father of three tells the nurse that he wants information on a vasectomy. What would the nurse tell him about ejaculate after a vasectomy?
Correct Answer: B
Rationale: The correct answer is B: There is no noticeable decrease in the amount of ejaculate even though it contains no sperm. After a vasectomy, the vas deferens, the tube that carries sperm from the testicles, is cut or blocked. This prevents sperm from being ejaculated, but the seminal fluid produced by the prostate and other glands still makes up the majority of the ejaculate volume. Therefore, although the ejaculate does not contain sperm after a vasectomy, there is no significant change in the amount of fluid ejaculated. Choice A is incorrect because the absence of sperm does not impact the volume of ejaculate. Choice C is incorrect as there is no marked decrease in ejaculate volume. Choice D is incorrect as there is no evidence to suggest that the viscosity of ejaculate changes post-vasectomy.
Question 7 of 9
Anti-infective prophylaxis is indicated for a pregnant patient with a history of mitral valve stenosis related to rheumatic heart disease because the patient is at risk of developing
Correct Answer: C
Rationale: The correct answer is C: bacterial endocarditis. Mitral valve stenosis increases the risk of bacterial endocarditis due to turbulent blood flow and potential damage to the heart valve. Prophylactic antibiotics are recommended before certain procedures to prevent bacterial endocarditis in patients with underlying cardiac conditions. Choice A, hypertension, is incorrect as mitral valve stenosis does not directly increase the risk of developing hypertension. Choice B, postpartum infection, is not directly related to the risk associated with mitral valve stenosis. Choice D, upper respiratory infections, is not a specific risk associated with mitral valve stenosis in pregnant patients.
Question 8 of 9
A patient with a hip fracture is having difficulty defecating into a bedpan while lying in bed. Which action by the nurse will assist the patient in having a successful bowel movement?
Correct Answer: D
Rationale: Rationale: Option D is correct because raising the head of the bed promotes a more natural position for defecation, allowing gravity to assist. This position helps align the rectum and anal canal, making it easier for the patient to have a bowel movement. Administering laxatives (Option C) may help, but adjusting the bed position is a non-invasive and more immediate intervention. Withholding pain medication (Option B) could lead to unnecessary discomfort for the patient. Administering a barium enema (Option A) is not indicated for addressing difficulty with defecation.
Question 9 of 9
An adult oncology patient has a diagnosis of bladder cancer with metastasis and the patient has asked the nurse about the possibility of hospice care. Which principle is central to a hospice setting?
Correct Answer: A
Rationale: The correct answer is A: The patient and family should be viewed as a single unit of care. In hospice care, the focus is on providing holistic care not only to the patient but also to their family members. This approach recognizes that the patient's well-being is interconnected with that of their loved ones. By viewing the patient and family as a single unit of care, hospice providers can address not just the physical symptoms but also the emotional, social, and spiritual needs of both the patient and their family. This principle emphasizes the importance of supporting the patient and their family through the end-of-life journey. Summary: - Choice B is incorrect as hospice care aims to manage symptoms effectively to improve quality of life. - Choice C is incorrect as hospice care typically involves a collaborative interdisciplinary team working towards common goals. - Choice D is incorrect as hospice care often prioritizes providing end-of-life care in a comfortable setting preferred by the patient.