ATI RN
foundations of nursing practice questions Questions
Question 1 of 9
A patient is experiencing oliguria. Which actionshould the nurse performfirst?
Correct Answer: A
Rationale: The correct answer is A: Assess for bladder distention. Oliguria indicates decreased urine output, which could be due to urinary retention. Assessing for bladder distention helps identify the underlying cause. Requesting diuretics (B) without assessing first is premature. Increasing IV fluid rate (C) may worsen the situation if there is urinary retention. Encouraging caffeinated beverages (D) is not appropriate as they can worsen dehydration.
Question 2 of 9
A patient is 24 hours postoperative following prostatectomy and the urologist has ordered continuous bladder irrigation. What color of output should the nurse expect to find in the drainage bag?
Correct Answer: A
Rationale: The correct answer is A: Red wine colored. Following a prostatectomy, continuous bladder irrigation is commonly used to prevent blood clots and ensure urine drainage. The output is expected to be red wine colored, indicating the presence of blood in the urine due to surgical trauma. Tea-colored (choice B) or amber (choice C) are not specific enough and do not accurately reflect the expected bloody output. Light pink (choice D) may suggest a lower level of bleeding compared to red wine color, but it is not the most accurate description for post-prostatectomy drainage.
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 public health nurse has formed an interdisciplinary team that is developing an educational program entitled Cancer: The Risks and What You Can Do About Them. Participants will receive information, but the major focus will be screening for relevant cancers. This program is an example of what type of health promotion activity?
Correct Answer: C
Rationale: The correct answer is C: Secondary prevention. This program focuses on screening for relevant cancers, which is a key component of secondary prevention aimed at early detection and treatment to reduce the impact of the disease. Secondary prevention aims to identify and treat health conditions in their early stages. Disease prophylaxis (A) focuses on preventing the occurrence of a disease, while risk reduction (B) aims to lower the chances of developing a disease. Tertiary prevention (D) involves managing and improving outcomes for individuals already diagnosed with a disease. In this scenario, the emphasis on screening aligns closely with the goals of secondary prevention, making it the most appropriate choice.
Question 5 of 9
A patient is exploring treatment options after being diagnosed with age-related cataracts that affect her vision. What treatment is most likely to be used in this patients care?
Correct Answer: D
Rationale: The correct answer is D: Surgical intervention. Cataracts are a clouding of the lens in the eye, which can lead to vision impairment. Surgery is the most common and effective treatment for cataracts, involving the removal of the cloudy lens and replacement with an artificial one. Antioxidant supplements (Choice A) may help prevent cataracts but are not a treatment for existing ones. Eyeglasses or magnifying lenses (Choice B) can help with vision correction but do not address the cataracts themselves. Corticosteroid eye drops (Choice C) are used for treating inflammation in the eye, not cataracts. Therefore, surgical intervention is the most appropriate treatment option for age-related cataracts.
Question 6 of 9
The nurse asks a patient where the pain is, andthe patient responds by pointing to the area of pain. Which form of communication did the patient use?
Correct Answer: B
Rationale: The correct answer is B: Nonverbal. The patient used nonverbal communication by pointing to the area of pain, which is a form of expressing information without words. This choice is correct because pointing is a nonverbal gesture that conveys a specific message. Verbal communication (A) involves spoken or written words, which were not used in this scenario. Intonation (C) refers to the rise and fall of the voice in speech, which was not demonstrated by the patient. Vocabulary (D) is the range of words known or used by a person, but the patient did not use words to communicate in this situation. In summary, the patient used nonverbal communication through pointing, making choice B the correct answer.
Question 7 of 9
A patient who had premature rupture of the membranes (PROM) earlier in the pregnancy at 28 weeks returns to the labor unit 1 week later complaining that she is now in labor. The labor and birth nurse performs the NfollRowiIng aGssesBsm.eCntsM. The vaginal exam is deferred until the U S N T O physician is in attendance. The patient is placed on electronic fetal monitoring (EFM) and a baseline FHR of 130 bpm is noted. No contraction pattern is observed. The patient is then transferred to the antepartum unit for continued observation. Several hours later, the patient complains that she does not feel the baby move. Examination of the abdomen reveals a fundal height of 34 cm. Muscle tone is no different from earlier in the hospital admission. The patient is placed on the EFM and no fetal heart tones are observed. What does the nurse suspect is occurring?
Correct Answer: D
Rationale: The correct answer is D: Hidden placental abruption. In this scenario, the patient had PROM and is now presenting with decreased fetal movement and absence of fetal heart tones after a fundal height increase. These signs suggest a hidden placental abruption, where the placenta has partially detached, leading to fetal distress and potential fetal demise. The absence of contractions rules out active labor (B) as the cause. Placental previa (A) would typically present with painless vaginal bleeding, which is not described in the scenario. Placental abruption (C) usually presents with painful vaginal bleeding, which is also not mentioned. Therefore, the most likely explanation for the symptoms described is a hidden placental abruption.
Question 8 of 9
Which finding in the exam of a patient with a diagnosis of threatened abortion would change the diagnosis to inevitable abortion?
Correct Answer: C
Rationale: The correct answer is C: Clear fluid from vagina. In threatened abortion, there is vaginal bleeding but the cervix is closed, indicating the possibility of the pregnancy continuing. If clear fluid is present, it suggests rupture of the amniotic sac, leading to inevitable abortion. Backache (A) and pelvic pressure (D) can be common symptoms in both threatened and inevitable abortion. A rise in hCG level (B) alone does not indicate a change from threatened to inevitable abortion.
Question 9 of 9
A patient is beginning an antiretroviral drug regimen shortly after being diagnosed with HIV. What nursing action is most likely to increase the likelihood of successful therapy?
Correct Answer: B
Rationale: The correct answer is B: Addressing possible barriers to adherence. This is crucial because adherence to the antiretroviral drug regimen is key for successful therapy in HIV patients. By identifying and addressing barriers such as medication side effects, cost, or forgetfulness, nurses can help patients stay on track with their treatment. Other choices are incorrect: A: Promoting complementary therapies is not the priority in initiating antiretroviral therapy. Adherence to the prescribed regimen is more critical. C: Educating about the pathophysiology of HIV is important, but it may not directly impact the success of the therapy as much as addressing adherence barriers. D: While follow-up blood work is necessary, it is not as immediate and impactful as addressing adherence barriers at the beginning of therapy.