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
Which intrapartal assessment should be avoided when caring for a patient with HELLP syndrome?
Correct Answer: A
Rationale: The correct answer is A: Abdominal palpation. Palpating the abdomen can potentially cause rupture of the liver in patients with HELLP syndrome due to increased risk of liver hematoma. This can lead to severe bleeding and compromise the patient's condition. Checking deep tendon reflexes (C), auscultation of the heart and lungs (D), and venous sample of blood (B) are safe assessments that do not pose a risk of exacerbating the patient's condition. It is crucial to prioritize patient safety and avoid interventions that can harm the patient, making avoiding abdominal palpation the correct choice in caring for a patient with HELLP syndrome.
Question 3 of 9
A nurse is preparing a bowel training programfor a patient. Which actions will the nurse take? (Select all that apply.)
Correct Answer: A
Rationale: The correct answer is A. Recording times when the patient is incontinent is crucial in identifying patterns and establishing a structured bowel training program. This data helps in determining the optimal timing for toileting. Choices B, C, and D are incorrect. Choice B is not specific to bowel training and may not address the patient's individual needs. Choice C is not a recommended posture for effective bowel elimination. Choice D, while important for overall health, is not directly related to bowel training.
Question 4 of 9
A nurse is preparing to document a patient whohas chest pain. Which information is critical for the nurse to include?
Correct Answer: D
Rationale: The correct answer is D because documenting the patient's pain intensity using a pain scale (8 out of 10) is crucial for assessing the severity of the chest pain. This information helps in determining the appropriate intervention and monitoring the effectiveness of treatment. Choice A is irrelevant as it does not provide any useful information about the patient's condition. Choice B is important for neurological assessment but not specifically related to chest pain. Choice C is not as critical as knowing the current pain level.
Question 5 of 9
A nurse is caring for an 87-year-old Mexican-American female patient who is in end-stage renal disease. The physician has just been in to see the patient and her family to tell them that nothing more can be done for the patient and that death is not far. The physician offers to discharge the patient home to hospice care, but the patient and family refuse. After the physician leaves, the patients daughter approaches you and asks what hospice care is. What would this lack of knowledge about hospice care be perceived as?
Correct Answer: C
Rationale: The correct answer is C: A barrier to hospice care for this patient. The lack of knowledge about hospice care can be perceived as a barrier to accessing this type of care for the patient and her family. Understanding hospice care is crucial in making informed decisions about end-of-life care options. This lack of knowledge does not necessarily indicate lack of education (choice A), language barrier (choice B), or inability to grasp American concepts of health care (choice D), as hospice care is a universal concept that transcends cultural and educational backgrounds.
Question 6 of 9
A nurse has provided care to a patient. Whichentry should the nurse document in the patient’s record?
Correct Answer: C
Rationale: The correct answer is C because it provides specific, objective information about the patient's left knee incision, including its size and absence of concerning signs. This entry is relevant, concise, and focuses on a specific aspect of the patient's condition, aiding in continuity of care and treatment planning. Choice A is vague and lacks detail, making it insufficient for accurate patient care documentation. Choice B focuses on the patient's subjective feelings and does not provide objective assessment data. Choice D is judgmental and includes unnecessary information about the patient's behavior and family presence, which is not directly related to the patient's condition.
Question 7 of 9
A patient newly diagnosed with breast cancer states that her physician suspects regional lymph node involvement and told her that there are signs of metastatic disease. The nurse learns that the patient has been diagnosed with stage IV breast cancer. What is an implication of this diagnosis?
Correct Answer: A
Rationale: Rationale for Correct Answer A: Stage IV breast cancer indicates distant metastasis, making the patient ineligible for curative surgery. Treatment for stage IV focuses on palliative care to manage symptoms and improve quality of life. Summary of Other Choices: B: Stage IV breast cancer is not considered highly treatable as it has spread beyond the breast and nearby lymph nodes, making it more challenging to cure. C: There is no evidence to suggest that stage IV breast cancer will self-resolve. The prognosis for metastatic breast cancer is typically poor. D: The 5-year survival rate for stage IV breast cancer is generally lower than 15%, making this choice incorrect.
Question 8 of 9
A patient with otosclerosis has significant hearing loss. What should the nurse do to best facilitate communication with the patient?
Correct Answer: A
Rationale: The correct answer is A: Sit or stand in front of the patient when speaking. This choice is correct because it allows the patient with otosclerosis to directly see the nurse's face and lip movements, aiding in lip-reading and understanding speech. Sitting or standing in front of the patient also ensures better eye contact and reduces background noise interference. Choice B is incorrect because exaggerated lip and mouth movements may distort speech and make it harder for the patient to understand. Choice C is incorrect because standing in front of a light or window can create glare and make it difficult for the patient to see the nurse's face clearly. Choice D is incorrect because saying the patient's name loudly before starting to talk does not directly address the communication needs of a patient with otosclerosis.
Question 9 of 9
A 16-year-old has come to the clinic and asks to talk to a nurse. The nurse asks the teen what she needs and the teen responds that she has become sexually active and is concerned about getting HIV. The teen asks the nurse what she can do keep from getting HIV. What would be the nurses best response?
Correct Answer: D
Rationale: The correct answer is D because it emphasizes the importance of consistent and correct condom use in preventing HIV transmission. Here's the rationale: 1. Abstinence is the most effective way to prevent HIV, but since the teen is sexually active, abstinence may not be feasible for her. 2. Using condoms consistently and correctly is the next best method for preventing HIV transmission during sexual activity. 3. Choice A is incorrect because it implies that using condoms is not effective, which is not true. 4. Choice B is incorrect because it only mentions female condoms, while both male and female condoms can be effective in preventing HIV. 5. Choice C is incorrect because while new prevention methods are being researched, the established method of consistent condom use remains the most effective.