ATI RN
Introduction to Nursing Final Exam Quizlet Questions
Question 1 of 5
A patient has had recent mechanical heart valve surgery and is receiving anticoagulant therapy. While monitoring the patient‘s laboratory work, the nurse interprets that the patient‘s international normalized ratio (INR) level of 3 indicates that:
Correct Answer: B
Rationale: The correct answer is B: the patient's warfarin dose is at therapeutic levels. An INR level of 3 indicates the patient's blood is anticoagulated within the therapeutic range for mechanical heart valve surgery. This level helps prevent blood clots while minimizing the risk of bleeding. Choices A, C, and D are incorrect because an INR of 3 is not too low for warfarin therapy, not indicative of dangerously high heparin dose, and not related to heparin therapy. Overall, an INR of 3 is within the desired range for anticoagulation therapy post mechanical heart valve surgery.
Question 2 of 5
An emergency department nurse assesses a female client. Which assessment findings would alert the nurse to request a prescription for an electrocardiogram? (Select the one that does not apply.)
Correct Answer: D
Rationale: The correct answer is D. Abdominal pain does not typically prompt a need for an electrocardiogram (ECG) as it is not a common symptom associated with cardiac issues. Hypertension (A), fatigue despite adequate rest (B), and indigestion (C) are all potential signs of underlying cardiac problems that could necessitate an ECG to assess the heart's electrical activity. Abdominal pain is more likely related to gastrointestinal issues rather than cardiac concerns.
Question 3 of 5
On auscultation of a patient’s lungs, the nurse hears low-pitched, bubbling sounds during inhalation in the lower third bilaterally. How should the nurse document this finding?
Correct Answer: A
Rationale: The correct answer is A: Inspiratory crackles at the bases. Crackles are abnormal lung sounds caused by air passing through fluid in the alveoli or small airways. In this case, the low-pitched bubbling sounds heard during inhalation in the lower third bilaterally indicate the presence of inspiratory crackles at the bases. This finding suggests fluid accumulation in the lungs, commonly seen in conditions such as pneumonia or heart failure affecting the bases. The other choices are incorrect because expiratory wheezes typically indicate asthma or COPD, abnormal lung sounds in the apices suggest conditions like tuberculosis, and pleural friction rub is characterized by a grating sound heard during both inspiration and expiration, commonly associated with pleurisy or pleural inflammation, not fluid-filled alveoli.
Question 4 of 5
A patient is hospitalized with active tuberculosis (TB). Which assessment finding indicates to the nurse that prescribed airborne precautions are likely to be discontinued?
Correct Answer: D
Rationale: The correct answer is D because negative sputum smears for acid-fast bacilli indicate reduced infectivity and lower risk of transmission. This means the patient is likely non-infectious and can discontinue airborne precautions. Choice A is incorrect because upper lobe infiltrates are common in TB. Choice B is incorrect as TB treatment usually lasts 6-9 months. Choice C is incorrect because an induration of 10 mm on Mantoux testing indicates exposure to TB, not readiness to discontinue precautions.
Question 5 of 5
A nurse cares for a client who is scheduled for a total laryngectomy. What action would the nurse take prior to surgery?
Correct Answer: C
Rationale: The correct answer is C. Prior to total laryngectomy, the nurse should assist the client to choose a communication method as the client will lose their ability to speak post-surgery. This step is crucial for the client's psychosocial well-being and quality of life. Assessing airway patency, breathing, and circulation (A) is important but is typically done as part of routine preoperative assessment and not specific to laryngectomy. Administering pain medication (B) is important but is not the priority before surgery, as the client may not be in pain at that moment. Ambulating the client (D) is not necessary before laryngectomy and does not address the client's communication needs.