ATI RN
foundations of nursing practice questions Questions
Question 1 of 9
A patient has just died following urosepsis that progressed to septic shock. The patients spouse says, I knew this was coming, but I feel so numb and hollow inside. The nurse should know that these statements are characteristic of what?
Correct Answer: A
Rationale: The correct answer is A: Complicated grief and mourning. This is characterized by a sense of emotional numbness and feeling hollow inside, which the patient's spouse is experiencing after the patient's death. Complicated grief involves intense and prolonged mourning that may interfere with daily functioning. Other choices are incorrect because: B: Uncomplicated grief and mourning typically involves a range of emotions, including sadness and sorrow, but not the profound numbness and emptiness described. C: Depression stage of dying refers to a stage in the Kubler-Ross model, but the patient's spouse is not the one dying, so this does not apply. D: Acceptance stage of dying involves coming to terms with one's impending death, not the aftermath of losing a loved one to sepsis.
Question 2 of 9
In providing diabetic teaching for a patient with type 1 diabetes mellitus, which instructions will the nurse provide to the patient?
Correct Answer: B
Rationale: The correct answer is B: Saturated fat should be limited to less than 7% of total calories. This is because limiting saturated fat intake is crucial in managing type 1 diabetes to reduce the risk of cardiovascular diseases. Saturated fats can worsen insulin resistance and lead to complications. Choice A is incorrect as diabetic management involves more than just insulin. Choice C is incorrect because nonnutritive sweeteners should be used in moderation due to potential side effects. Choice D is incorrect as individuals with diabetes should aim to keep cholesterol intake low to prevent heart problems.
Question 3 of 9
A nurse believes that the nurse-patient relationshipis a partnership and that both are equal participants. Which term should the nurse use to describe this belief?
Correct Answer: C
Rationale: The correct term to describe the belief that the nurse-patient relationship is a partnership where both are equal participants is "Mutuality" (C). This term emphasizes the idea of shared responsibility, respect, and collaboration between the nurse and the patient. It signifies a relationship built on equality and mutual understanding, fostering trust and positive outcomes. Choice A (Critical thinking) involves analyzing and evaluating information, which is essential for decision-making but does not directly reflect the equality and partnership aspect of the nurse-patient relationship. Choice B (Authentic) relates to being genuine and true to oneself, which is important in building trust but does not specifically address the equal participation aspect in the relationship. Choice D (Attend) means to be present or pay attention, which is a fundamental aspect of nursing care but does not capture the full essence of a partnership based on equality and mutual involvement.
Question 4 of 9
A hospital nurse has experienced percutaneous exposure to an HIV-positive patients blood as a result of a needlestick injury. The nurse has informed the supervisor and identified the patient. What action should the nurse take next?
Correct Answer: B
Rationale: The correct answer is B: Report to the emergency department or employee health department. 1. Immediate action is crucial after exposure to HIV-positive blood. 2. Reporting to the emergency department or employee health department ensures prompt evaluation and appropriate management. 3. The supervisor should also be informed to initiate the necessary protocols. 4. The other choices are incorrect: - A: Chlorhexidine may not be sufficient for post-exposure prophylaxis. - C: Hydrocolloid dressing is not appropriate for managing needlestick injuries. - D: Following up with the primary care provider may cause delays in receiving timely post-exposure prophylaxis.
Question 5 of 9
A patients most recent diagnostic imaging has revealed that his lung cancer has metastasized to his bones and liver. What is the most likely mechanism by which the patients cancer cells spread?
Correct Answer: A
Rationale: The correct answer is A: Hematologic spread. In this case, the cancer cells have traveled through the bloodstream to reach the bones and liver. This process is known as hematologic spread, where cancer cells enter the blood vessels and spread to distant organs. Lymphatic circulation (B) involves the spread of cancer cells through the lymphatic system, which is less likely in this scenario. Invasion (C) refers to cancer cells infiltrating nearby tissues, not distant organs. Angiogenesis (D) is the process of new blood vessel formation to support tumor growth, but it does not explain the spread of cancer cells to other organs.
Question 6 of 9
The nurse is planning the care of a patient with a diagnosis of vertigo. What nursing diagnosis risk should the nurse prioritize in this patients care?
Correct Answer: C
Rationale: The correct answer is C: Risk for falls. Patients with vertigo experience a false sensation of spinning or movement, which can lead to imbalance and increased risk of falls. Prioritizing the risk for falls is crucial to prevent injuries and ensure patient safety. Other choices are incorrect as they do not directly address the immediate safety concern of falls associated with vertigo. A: Risk for disturbed sensory perception may be present, but the priority is preventing falls. B: Risk for unilateral neglect is not typically associated with vertigo. D: Risk for ineffective health maintenance is important but falls take precedence due to the immediate risk of injury.
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 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 9 of 9
A patient has sought care, stating that she developed hives overnight. The nurses inspection confirms the presence of urticaria. What type of allergic hypersensitivity reaction has the patient developed?
Correct Answer: A
Rationale: The correct answer is A: Type I hypersensitivity reaction. This type of reaction involves the release of histamine from mast cells and basophils, leading to symptoms like hives. It is characterized by the involvement of IgE antibodies. In this case, the patient developed hives quickly after exposure to the allergen, indicating an immediate hypersensitivity reaction typical of Type I. Choices B, C, and D are incorrect because they are associated with different mechanisms and timeframes of hypersensitivity reactions. Type II involves antibody-mediated cell destruction, Type III involves immune complex deposition, and Type IV is a delayed-type hypersensitivity reaction mediated by T cells, none of which are consistent with the rapid onset of hives seen in this patient.