ATI RN
foundation of nursing questions and answers Questions
Question 1 of 9
A nurse practitioner assesses the patient and diagnoses Gardnerella vaginalis. What would be the most appropriate nursing action at this time?
Correct Answer: A
Rationale: The correct answer is A: Advise the patient that this is an overgrowth of normal vaginal flora. This is correct because Gardnerella vaginalis is a bacteria associated with bacterial vaginosis, which is an overgrowth of normal vaginal flora. By advising the patient of this, the nurse practitioner can provide education on the condition and treatment options. B: Discussing the effect of this diagnosis on the patient's fertility is incorrect as Gardnerella vaginalis is not typically associated with fertility issues. C: Documenting the vaginal discharge as normal is incorrect as Gardnerella vaginalis is indicative of an abnormal vaginal flora imbalance. D: Administering acyclovir as ordered is incorrect as acyclovir is an antiviral medication used to treat herpes simplex virus infections, not bacterial vaginosis caused by Gardnerella vaginalis.
Question 2 of 9
A 29-year-old patient has just been told that he has testicular cancer and needs to have surgery. During a presurgical appointment, the patient admits to feeling devastated that he requires surgery, stating that it will leave him emasculated and a shell of a man. The nurse should identify what nursing diagnosis when planning the patients subsequent care?
Correct Answer: A
Rationale: The correct answer is A: Disturbed Body Image Related to Effects of Surgery. This nursing diagnosis is appropriate because the patient expresses concerns about feeling emasculated and a shell of a man after the surgery, indicating a disturbance in his body image. The patient's perception of how the surgery will affect his masculinity is a clear indication of body image disturbance. Choice B is incorrect because there is no mention of spiritual distress in the patient's statements. Choice C is incorrect as there is no indication that the patient will experience social isolation specifically related to the surgery. Choice D is incorrect as the patient's concerns are primarily related to his body image and not loneliness.
Question 3 of 9
A 54-year-old has a diagnosis of breast cancer and is tearfully discussing her diagnosis with the nurse. The patient states, They tell me my cancer is malignant, while my coworkers breast tumor was benign. I just dont understand at all. When preparing a response to this patient, the nurse should be cognizant of what characteristic that distinguishes malignant cells from benign cells of the same tissue type?
Correct Answer: D
Rationale: The correct answer is D: Different molecular structure in the cells. Malignant cells have alterations in their molecular structure, leading to uncontrolled growth and invasion of surrounding tissues, while benign cells retain their normal molecular structure and do not invade nearby tissues. This distinction is crucial in understanding why malignant cells are cancerous and pose a greater risk compared to benign cells. Other choices are incorrect because: A: Slow rate of mitosis of cancer cells - Malignant cells actually have a rapid rate of mitosis, contributing to their uncontrolled growth. B: Different proteins in the cell membrane - While there may be differences in proteins, the molecular structure is a more fundamental difference between malignant and benign cells. C: Differing size of the cells - Cell size alone is not a definitive characteristic that distinguishes between malignant and benign cells; molecular structure plays a more significant role.
Question 4 of 9
Which nursing actions will the nurse implementwhen collecting a urine specimen from a patient? (Select all that apply.)
Correct Answer: B
Rationale: The correct answer is B: Labeling all specimens with date, time, and initials. This is important for proper identification and tracking of the specimen. - Choice A is incorrect because urine cultures typically take longer than 12 hours to grow. - Choice C is incorrect as privacy is important but not a specific action related to urine specimen collection. - Choice D is incorrect as wearing gown, gloves, and mask may not be necessary for routine urine specimen collection, unless there are specific precautions needed.
Question 5 of 9
Before giving the patient an intermittent gastric tube feeding, what should the nurse do?
Correct Answer: B
Rationale: The correct answer is B because injecting air into the stomach via the tube and auscultating helps confirm the tube placement in the stomach before administering the feeding. This step ensures the safety of the patient by preventing accidental lung feeding. Choice A is incorrect because securing the tube with a safety pin to the gown is not a standard practice and can lead to complications. Choice C is incorrect because the temperature of the feeding does not affect the tube placement or safety. Choice D is incorrect because checking the pH level is not a reliable method for verifying tube placement.
Question 6 of 9
A patient has had a total mastectomy with immediate reconstruction. The patient asks the nurse when she can take a shower. What should the nurse respond?
Correct Answer: A
Rationale: The correct answer is A: Not until the drain is removed. After a mastectomy with immediate reconstruction, there is typically a drain in place to collect fluid. Showering before the drain is removed can increase the risk of infection and disrupt the healing process. It is important to wait until the healthcare provider removes the drain to ensure proper healing and reduce the risk of complications. Summary: B: On the second postoperative day - Too early, the drain needs to be removed first. C: Now, if you wash gently with soap and water - Incorrect, the drain should be removed before showering. D: Seven days after your surgery - Incorrect, waiting for a specific number of days is not necessary, it depends on when the drain is removed.
Question 7 of 9
A 76-year-old with a diagnosis of penile cancer has been admitted to the medical floor. Because the incidence of penile cancer is so low, the staff educator has been asked to teach about penile cancer. What risk factors should the educator cite in this presentation? Select all that apply.
Correct Answer: A
Rationale: The correct answer is A: Phimosis. Phimosis, the inability to retract the foreskin over the glans penis, is a significant risk factor for penile cancer. Phimosis can lead to poor hygiene, inflammation, and chronic irritation, increasing the risk of cancer development. The other choices (B: Priapism, C: Herpes simplex infection, D: Increasing age, E: Lack of circumcision) are not directly linked to penile cancer development. Priapism is prolonged and painful erection unrelated to penile cancer. Herpes simplex infection is a viral infection and not a primary risk factor for penile cancer. Increasing age is a general risk factor for many cancers, but it is not specific to penile cancer. Lack of circumcision has been associated with a slightly higher risk of penile cancer, but it is not as significant as phimosis.
Question 8 of 9
A nurse has made a referral to a grief support group, knowing that many individuals find these both comforting and beneficial after the death of a loved one. What is the most important accomplishment available by attending a grief support group?
Correct Answer: D
Rationale: The correct answer is D: Normalization of feelings and experiences. Attending a grief support group helps individuals feel validated and understood by others who are going through similar emotions. This normalization can reduce feelings of isolation and provide a sense of belonging, which is crucial in the grieving process. It also allows individuals to recognize that their feelings and experiences are common reactions to loss. Choice A is incorrect because a grief support group focuses more on accepting and processing the new reality rather than incorporating the old life into it. Choice B is incorrect as it suggests maintaining the old life rather than adjusting to a new normal. Choice C is incorrect because the focus of a grief support group is not solely on social skills but on emotional support and coping mechanisms.
Question 9 of 9
A 27-year-old female patient is diagnosed with invasive cervical cancer and is told she needs to have a hysterectomy. One of the nursing diagnoses for this patient is disturbed body image related to perception of femininity. What intervention would be most appropriate for this patient?
Correct Answer: B
Rationale: The correct answer is B: Reassure the patient that she does not have to have sex to be feminine. Rationale: 1. Acknowledges patient's feelings: By reassuring the patient that she does not have to have sex to be feminine, the nurse validates the patient's emotions and concerns. 2. Addresses societal norms: This intervention challenges societal stereotypes that equate femininity solely with reproductive capabilities. 3. Promotes self-acceptance: Encouraging the patient to embrace her femininity beyond physical aspects fosters self-acceptance and self-worth. 4. Supports holistic care: Recognizing the multifaceted nature of femininity shows a holistic approach to addressing the patient's body image issues. Summary: A, C, and D are incorrect as they do not directly address the patient's specific concerns about her body image and femininity. Choice B is the most appropriate intervention as it validates the patient's feelings and challenges societal norms, promoting self-acceptance and holistic care