ATI RN
foundations of nursing practice questions Questions
Question 1 of 9
A patient who has had a lumpectomy calls the clinic to talk to the nurse. The patient tells the nurse that she has developed a tender area on her breast that is red and warm and looks like someone drew a line with a red marker. What would the nurse suspect is the womans problem?
Correct Answer: A
Rationale: The correct answer is A: Mondor disease. This condition presents as a superficial thrombophlebitis of the breast veins, causing a tender, red, warm, cord-like area resembling a red line. This is typically benign and self-limiting. B: Deep vein thrombosis (DVT) of the breast is unlikely as it typically involves deeper veins in the extremities. C: Recurrent malignancy is less likely as the symptoms described are more indicative of a benign condition like Mondor disease. D: An area of fat necrosis is also less likely as it usually presents as a painless, firm lump rather than a red, warm, tender area.
Question 2 of 9
The nurse is assessing a patient for nutritional status. Which action will the nurse take?
Correct Answer: D
Rationale: The correct answer is D, combining multiple objective measures with subjective measures. This approach provides a comprehensive assessment of the patient's nutritional status by incorporating both quantitative data (objective measures) such as weight, BMI, and laboratory values, as well as qualitative information (subjective measures) like dietary history and appetite changes. By combining these measures, the nurse can obtain a more holistic view of the patient's nutritional status, allowing for better identification of nutritional deficiencies or excesses. This method enhances the accuracy and reliability of the assessment compared to relying solely on one type of measure. Choice A is incorrect because nutritional assessment is crucial even in the presence of chronic disease to address potential malnutrition risks. Choice B is incorrect as the Mini Nutritional Assessment is not intended for pediatric patients but for adults. Choice C is incorrect as using a single tool may not capture the full complexity of the patient's nutritional status.
Question 3 of 9
A public health nurse is preparing an educational campaign to address a recent local increase in the incidence of HIV infection. The nurse should prioritize which of the following interventions?
Correct Answer: B
Rationale: The correct answer is B: Educational programs that focus on control and prevention. This intervention is the most crucial as it directly addresses the issue of the increasing incidence of HIV infection. By providing education on how to control and prevent the spread of HIV, the nurse can empower the community to take proactive measures to reduce transmission rates. A: Lifestyle actions that improve immune function may be helpful in general health promotion but do not directly target the prevention of HIV transmission. C: Appropriate use of standard precautions is important but is more focused on healthcare settings rather than community-wide prevention efforts. D: Screening programs for youth and young adults are valuable but may not be as effective as educational programs in preventing the spread of HIV.
Question 4 of 9
A patient has been diagnosed with endometriosis. When planning this patients care, the nurse should prioritize what nursing diagnosis?
Correct Answer: B
Rationale: The correct answer is B: Acute pain related to misplaced endometrial tissue. This nursing diagnosis should be prioritized because endometriosis commonly presents with severe pelvic pain. Managing pain is crucial for the patient's comfort and quality of life. Anxiety (choice A) is not the priority as pain management takes precedence. Ineffective tissue perfusion (choice C) is not a priority unless the patient is actively hemorrhaging. Excess fluid volume (choice D) is not typically associated with endometriosis. Prioritizing pain management will address the immediate and most distressing symptom for the patient.
Question 5 of 9
The nurse is admitting a 55-year-old male patient diagnosed with a retinal detachment in his left eye. While assessing this patient, what characteristic symptom would the nurse expect to find?
Correct Answer: A
Rationale: Step-by-step rationale for why A is correct: 1. Retinal detachment causes traction on the retina. 2. Traction on the retina can stimulate photoreceptors. 3. Stimulation of photoreceptors can lead to perception of flashing lights. 4. Therefore, the characteristic symptom of retinal detachment is flashing lights in the visual field. Summary: B: Sudden eye pain is not a characteristic symptom of retinal detachment. C: Loss of color vision is not typically associated with retinal detachment. D: Colored halos around lights are more indicative of conditions like glaucoma or corneal edema, not retinal detachment.
Question 6 of 9
A patient is brought to the emergency department (ED) in a state of anaphylaxis. What is the ED nurses priority for care?
Correct Answer: B
Rationale: The correct answer is B: Protect the patient's airway. In anaphylaxis, airway compromise can lead to respiratory distress and even respiratory arrest. The priority is to ensure the patient has a patent airway to maintain oxygenation. This can be achieved through interventions such as positioning, oxygen therapy, and potentially intubation if needed. Monitoring the patient's level of consciousness (A) is important but secondary to ensuring airway patency. Providing psychosocial support (C) is not the immediate priority in anaphylaxis. Administering medications (D) is also important but only after ensuring the airway is protected.
Question 7 of 9
A patient is to undergo an ultrasound-guided core biopsy. The patient tells the nurse that a friend of hers had a stereotactic core biopsy. She wants to understand the differences between the two procedures.What would be the nurses best response?
Correct Answer: A
Rationale: The correct answer is A because an ultrasound-guided core biopsy is indeed faster, less expensive, and does not use radiation. - "Faster": Ultrasound-guided biopsies are typically quicker compared to stereotactic biopsies, as they are performed in real-time using ultrasound imaging. - "Less expensive": Ultrasound-guided biopsies are generally more cost-effective than stereotactic biopsies due to the equipment and resources required. - "Does not use radiation": Unlike stereotactic biopsies which involve the use of X-rays for guidance, ultrasound-guided biopsies do not expose the patient to radiation, making them safer in that aspect. The other choices are incorrect because they either inaccurately state that ultrasound-guided biopsies use radiation (C), take more time (D), or imply a slight increase in cost without highlighting the key advantages of speed and lack of radiation (B).
Question 8 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 9 of 9
A patient has just returned to the unit from the PACU after surgery for a tumor within the spine. The patient complains of pain. When positioning the patient for comfort and to reduce injury to the surgical site, the nurse will position to patient in what position?
Correct Answer: B
Rationale: The correct answer is B: In a flat side-lying position. Rationale: 1. A flat side-lying position helps reduce pressure on the surgical site, promoting comfort and preventing injury. 2. This position minimizes strain on the spine and supports proper alignment. 3. High Fowlers position may increase pressure on the surgical area due to increased intra-abdominal pressure. 4. Trendelenberg position and reverse Trendelenberg position are not appropriate for spine surgery patients as they can cause increased blood flow to the surgical site, leading to potential complications.