ATI RN
foundations of nursing practice questions Questions
Question 1 of 9
A nurse is providing care to a patient with anindwelling catheter. Which practice indicates the nurse is following guidelines for avoiding catheter-associated urinary tract infection (CAUTI)?
Correct Answer: A
Rationale: The correct answer is A: Drapes the urinary drainage tubing with no dependent loops. This practice helps prevent CAUTI by ensuring that urine does not flow back into the bladder, reducing the risk of infection. Dependent loops can lead to stagnant urine, providing a breeding ground for bacteria. Choice B is incorrect because washing the drainage tube towards the meatus can introduce bacteria into the urinary tract, increasing the risk of infection. Choice C is incorrect because placing the drainage bag on the floor can introduce contaminants from the floor into the system. Choice D is incorrect because allowing the spigot to touch the receptacle can lead to contamination and increase the risk of infection.
Question 2 of 9
The nurse is using different toileting schedules.Which principles will the nurse keep in mind when planning care? (Select all that apply.)
Correct Answer: A
Rationale: The correct answer is A because habit training involves keeping a bladder diary to identify patterns and develop a toileting schedule. This helps in promoting regular voiding habits. B is incorrect because timed voiding isn't solely based on the patient's urge to void, but rather on a predetermined schedule. C is incorrect as prompted voiding involves reminding patients to use the restroom at regular intervals, not just asking if they are wet or dry. D is incorrect because elevating feet in patients with edema may help reduce swelling but has no direct impact on nighttime voiding.
Question 3 of 9
A patient has been living with seasonal allergies for many years, but does not take antihistamines, stating, When I was young I used to take antihistamines, but they always put me to sleep. How should the nurse best respond?
Correct Answer: C
Rationale: Rationale for Correct Answer (C): 1. The newer antihistamines, such as second-generation antihistamines like loratadine or cetirizine, are designed to cause less sedation compared to older antihistamines like diphenhydramine. 2. These newer antihistamines have a lower affinity for crossing the blood-brain barrier, reducing the sedative effects. 3. Therefore, suggesting that the newer antihistamines are different and cause less sedation is the best response to address the patient's concerns. Summary of Incorrect Choices: A. While some newer antihistamines may be combined with decongestants to offset drowsiness, this is not a consistent feature of all newer antihistamines. B. Developing tolerance to sedation after a few months is not a common or reliable response to antihistamines. D. Taking antihistamines at bedtime may help with sedation, but it does not address
Question 4 of 9
Which clinical intervention is the only known cure for preeclampsia?
Correct Answer: B
Rationale: The correct answer is B: Delivery of the fetus. The only known cure for preeclampsia is the delivery of the fetus, as this condition typically resolves after giving birth. Since preeclampsia can lead to serious complications for both the mother and baby, delivering the fetus is the most effective way to stop the progression of the condition. Magnesium sulfate (choice A) is used to prevent seizures in women with severe preeclampsia but does not cure the condition. Antihypertensive medications (choice C) are used to manage blood pressure in preeclampsia but do not cure it. Administration of aspirin (choice D) is used for prevention, not as a cure for preeclampsia.
Question 5 of 9
A patient has been diagnosed with endometriosis. When planning this patients care, the nurse should prioritize what nursing diagnosis?
Correct Answer: B
Rationale: The correct answer is B: Acute pain related to misplaced endometrial tissue. This nursing diagnosis should be prioritized because endometriosis commonly presents with severe pelvic pain. Managing pain is crucial for the patient's comfort and quality of life. Anxiety (choice A) is not the priority as pain management takes precedence. Ineffective tissue perfusion (choice C) is not a priority unless the patient is actively hemorrhaging. Excess fluid volume (choice D) is not typically associated with endometriosis. Prioritizing pain management will address the immediate and most distressing symptom for the patient.
Question 6 of 9
A patient with ovarian cancer is admitted to the hospital for surgery and the nurse is completing the patients health history. What clinical manifestation would the nurse expect to assess?
Correct Answer: B
Rationale: The correct answer is B: Increased abdominal girth. In ovarian cancer, a common clinical manifestation is the accumulation of fluid in the abdomen, leading to increased abdominal girth. This is known as ascites. The presence of ascites can be observed through physical examination and abdominal imaging. A: Fish-like vaginal odor is not typically associated with ovarian cancer. It may be a symptom of other gynecological conditions. C: Fever and chills are not specific to ovarian cancer and can be seen in various infectious or inflammatory conditions. D: Lower abdominal pelvic pain is a common symptom in many gynecological conditions but is not a specific manifestation of ovarian cancer.
Question 7 of 9
Massage around the feces and work down to remove.
Correct Answer: A
Rationale: The correct order for the massage is to start around the feces (4), then work downwards (1), followed by moving towards the sides (5), then back to the top (2), continuing to the sides again (3), and finally finishing at the top (6). This sequence ensures a thorough and effective massage process. Other choices have different orders that do not follow the logical flow of massaging around the feces and working down as specified in the question.
Question 8 of 9
A man tells the nurse that his father died of prostate cancer and he is concerned about his own risk of developing the disease, having heard that prostate cancer has a genetic link. What aspect of the pathophysiology of prostate cancer would underlie the nurses response?
Correct Answer: A
Rationale: The correct answer is A because several studies have indeed shown an association between BRCA-2 mutation and an increased risk of prostate cancer. BRCA-2 mutation is known to be linked to an increased risk of various cancers, including prostate cancer. This genetic mutation can be inherited and passed down through generations, leading to a higher likelihood of developing prostate cancer. Choices B, C, and D are incorrect because: B: HNPCC (Hereditary Nonpolyposis Colorectal Cancer) is not specifically associated with prostate cancer, and it is not an autosomal dominant mutation causing prostate cancer in men. C: TP53 gene is associated with other types of cancers, such as breast cancer, but not strongly linked to prostate cancer. D: Research has shown that genetics do play a role in the development of prostate cancer, contradicting the statement that genetics are unrelated to the disease.
Question 9 of 9
A patient is brought to the emergency department (ED) in a state of anaphylaxis. What is the ED nurses priority for care?
Correct Answer: B
Rationale: The correct answer is B: Protect the patient's airway. In anaphylaxis, airway compromise can lead to respiratory distress and even respiratory arrest. The priority is to ensure the patient has a patent airway to maintain oxygenation. This can be achieved through interventions such as positioning, oxygen therapy, and potentially intubation if needed. Monitoring the patient's level of consciousness (A) is important but secondary to ensuring airway patency. Providing psychosocial support (C) is not the immediate priority in anaphylaxis. Administering medications (D) is also important but only after ensuring the airway is protected.