ATI RN
foundation of nursing questions Questions
Question 1 of 9
A patient with a new diagnosis of amyotrophic lateral sclerosis (ALS) is overwhelmed by his diagnosis and the known complications of the disease. How can the patient best make known his wishes for care as his disease progresses?
Correct Answer: A
Rationale: The correct answer is A: Prepare an advance directive. This allows the patient to document their healthcare preferences in advance, ensuring their wishes are known and honored as the disease progresses. It provides clear instructions for healthcare providers and family members, reducing potential conflicts and ensuring the patient's autonomy is respected. Choice B is incorrect as designating an MRP focuses on medical decision-making but may not capture the full range of the patient's care preferences. Choice C involves collaboration with an organization, which may not fully represent the patient's individual wishes. Choice D is incorrect as witnesses are not always necessary for providing instructions, and the presence of witnesses does not guarantee that the patient's wishes will be followed accurately.
Question 2 of 9
The patient is asking the nurse about the best way to stay healthy. The nurse explains to the patient which teaching points? (Select all that apply.)
Correct Answer: A
Rationale: Step-by-step rationale for why choice A is correct: 1. Increasing physical activity helps in maintaining a healthy weight and overall health. 2. Regular exercise can reduce the risk of chronic diseases like heart disease and diabetes. 3. Physical activity improves mental health and overall well-being. 4. Exercise boosts immunity and helps in managing stress levels. Summary of why other choices are incorrect: B. Keeping total fat intake to 10% or less is a specific dietary recommendation and not a comprehensive approach to staying healthy. C. Maintaining body weight in a healthy range is important but does not encompass all aspects of staying healthy. D. Choosing and preparing foods with little salt is a specific dietary recommendation and does not address the importance of physical activity in staying healthy.
Question 3 of 9
A nurse is teaching preventative measures for otitis externa to a group of older adults. What action should the nurse encourage?
Correct Answer: A
Rationale: The correct answer is A: Rinsing the ears with normal saline after swimming. This is because rinsing with normal saline helps to remove excess moisture and debris, preventing bacterial growth that can lead to otitis externa. Avoiding loud noises (B) is important for overall ear health but does not specifically prevent otitis externa. Instilling antibiotic ointments regularly (C) is not recommended as it can disrupt the ear's natural flora. Avoiding cotton swabs (D) is important to prevent injury but does not directly prevent otitis externa.
Question 4 of 9
A patient has been referred to the breast clinic after her most recent mammogram revealed the presence of a lump. The lump is found to be a small, well-defined nodule in the right breast. The oncology nurse should recognize the likelihood of what treatment?
Correct Answer: A
Rationale: The correct answer is A: Lumpectomy and radiation. For a small, well-defined nodule in the breast, lumpectomy (removal of the lump) followed by radiation therapy is usually the treatment of choice for early-stage breast cancer. This approach aims to preserve the breast while ensuring effective treatment. Partial mastectomy (B) involves removing a larger portion of the breast tissue and is not typically necessary for a small, well-defined nodule. Chemotherapy (C) is generally used for more advanced stages of breast cancer or when the cancer has spread beyond the breast. Total mastectomy (D) is considered when the cancer is more extensive or in cases where lumpectomy is not feasible.
Question 5 of 9
The nurse and a colleague are performing the Epley maneuver with a patient who has a diagnosis of benign paroxysmal positional vertigo. The nurses should begin this maneuver by performing what action?
Correct Answer: B
Rationale: The correct answer is B: Assisting the patient into a sitting position. The Epley maneuver is used to treat benign paroxysmal positional vertigo by repositioning displaced calcium carbonate crystals in the inner ear. This maneuver involves a series of specific head movements. Starting with the patient in a sitting position allows for proper orientation and positioning for subsequent movements to be effective. Placing the patient in a prone position (A) would not facilitate the correct positioning for the maneuver. Instilling warm saline into the ear (C) is not part of the Epley maneuver. Assessing baseline hearing (D) is unrelated to performing the Epley maneuver.
Question 6 of 9
A nurse is assessing a 28-year-old man with HIV who has been admitted with pneumonia. In assessing the patient, which of the following observations takes immediate priority?
Correct Answer: B
Rationale: The correct answer is B: Tachypnea and restlessness. This observation takes immediate priority as it indicates potential respiratory distress, a common complication of pneumonia in HIV patients. Tachypnea can be a sign of hypoxia, while restlessness may indicate increased work of breathing. Prompt intervention is crucial to prevent respiratory failure. Choice A: Oral temperature of 100F is not an immediate priority as it is within normal range and may not directly impact the patient's immediate condition. Choice C: Frequent loose stools may suggest gastrointestinal issues but are not as urgent as respiratory distress in this scenario. Choice D: Weight loss of 1 pound since yesterday, while relevant in monitoring the patient's condition, does not require immediate intervention compared to respiratory distress.
Question 7 of 9
The clinic nurse is caring for a 42-year-old male oncology patient. He complains of extreme fatigue and weakness after his first week of radiation therapy. Which response by the nurse would best reassure this patient?
Correct Answer: A
Rationale: The correct answer is A because it acknowledges the patient's symptoms, reassures monitoring, and addresses the cause. It validates his experience while offering a proactive approach. Choice B is incorrect as it dismisses the patient's symptoms and can cause distress. Choice C is incorrect because it generalizes the patient's experience and lacks individualized care. Choice D is incorrect as it may give false hope and oversimplifies the situation. A provides the best balance of empathy and information for the patient's well-being.
Question 8 of 9
In the past three to four decades, nursing has moved into the forefront in providing care for the dying. Which phenomenon has most contributed to this increased focus of care of the dying?
Correct Answer: D
Rationale: The correct answer is D: Demographic changes in the population. This is because as the population ages, there is a higher prevalence of chronic illnesses and an increased number of people facing end-of-life care needs. This has led to a greater demand for palliative and hospice care services, shifting the focus of nursing towards providing care for the dying. A: Increased incidence of infections and acute illnesses is not the primary factor contributing to the increased focus on care for the dying. While these conditions do require nursing care, they do not directly explain the shift in focus. B: Increased focus of health care providers on disease prevention is important but does not directly explain the increased attention on care for the dying. Disease prevention aims to reduce the incidence of illnesses, not necessarily address end-of-life care needs. C: Larger numbers of people dying in hospital settings may be a consequence of the increased focus on care for the dying, but it is not the underlying phenomenon driving the shift in nursing care towards end-of
Question 9 of 9
The nurses plan of care for a patient with stage 3 HIV addresses the diagnosis of Risk for Impaired Skin Integrity Related to Candidiasis. What nursing intervention best addresses this risk?
Correct Answer: A
Rationale: The correct answer is A: Providing thorough oral care before and after meals. This addresses the risk for impaired skin integrity related to Candidiasis in patients with stage 3 HIV by preventing oral Candidiasis, a common fungal infection. Poor oral hygiene can lead to Candidiasis, which can spread to the skin. Thorough oral care reduces the risk of oral Candidiasis, thereby preventing skin integrity issues. Administering prophylactic antibiotics (B) is not indicated for preventing Candidiasis. Promoting nutrition and fluid intake (C) is important for overall health but does not directly address the risk of impaired skin integrity. Applying skin emollients (D) may help with skin dryness but does not directly address the underlying cause of Candidiasis.