ATI RN
Client Comfort and End of Care ATI Questions
Question 1 of 5
A patient with cancer pain is taking morphine for pain relief. Knowing constipation is a common side effect, what would the nurse recommend to the patient?
Correct Answer: B
Rationale: Morphine's opioid effect slows GI motility. 'Increase fluids and high-fiber foods, and use a mild laxative' is correcte.g., 2L water, prunes, and docusate prevent/treat constipation, per Taylor's management. Choice A, 'only when severe,' risks uncontrolled paine.g., cancer pain needs steady dosing. Choice C, 'enema every third day,' is invasivee.g., unnecessary vs. diet/laxatives. Choice D, 'nothing to worry about,' dismisses a real issuee.g., 50% of opioid users strain. Nurses teach proactive stepse.g., 'Drink more, try bran'balancing relief and side effects. Choice B is the practical, correct advice.
Question 2 of 5
Who or what plays the most influential role in the internalization of self-concept in children?
Correct Answer: B
Rationale: Children's self-concept internalizes through primary relationships. 'Parents' are most influentiale.g., a 5-year-old's 'I'm good' echoes parental praise, per Taylor's Erikson-based view, shaping identity via attachment and feedback. 'Peers' gain sway latere.g., adolescence, when 'cool' matters, not early core formation. 'School' reinforcese.g., grades boost esteembut follows home's lead. 'Church' impacts valuese.g., 'I'm kind'but less universally than parents. For example, a toddler mirrors a mother's tone'You're clever' builds self-knowledgeoutweighing a teacher's input at 3. Studies (e.g., attachment theory) show caregivers mold 70% of early self-perception, a nursing focus for family-centered care. Peers or institutions amplify, not originate, this. Choice B reflects this primary role correctly.
Question 3 of 5
A young woman has been in an automobile crash and sustained a laceration across the left side of her face, resulting in a large scar. What nursing diagnosis would be appropriate for this disfigurement?
Correct Answer: B
Rationale: Facial scarring alters self-view. 'Disturbed Body Image' fitse.g., 'I'm ugly now' reflects perception shift, per Taylor's NANDA, post-crash. 'Anxiety' may coexiste.g., 'Will it heal?'but isn't specific. 'Deficient Knowledge' is learning neede.g., scar care, not image. 'Impaired Memory' is cognitivee.g., unrelated to disfigurement. A scare.g., 5 cm across her cheektriggers esteem loss (e.g., avoiding mirrors), a nursing priority for counseling. Choice B is the correct, targeted diagnosis.
Question 4 of 5
Cold temperatures and loud noises are stressors to one person but not another. Why does this occur?
Correct Answer: C
Rationale: Stress varies by person. 'The perception and effects of stressors are highly individualized' explainse.g., cold bothers a thin person, not a hardy one, per Taylor's stress theory, due to appraisal and tolerance. Choice A, 'same perception,' is falsee.g., noise annoys one, not both. Choice B, 'same response,' ignorese.g., a musician loves loud, others hate it. Choice D, 'internal environment selective,' half-fitse.g., physiology matters, but perception's key. A nurse notes 'Cold kills me' vs. 'I'm fine'e.g., 50% report stress from noiseshowing subjectivity. Choice C is correct.
Question 5 of 5
An individual steps into a tub of very hot water and immediately jumps out again. What mechanism caused this response?
Correct Answer: B
Rationale: Hot water triggers instant withdrawal. 'Reflex pain response' caused ite.g., nociceptors signal spinal cord, pulling foot in 0.2 seconds, per Taylor's neurology, a protective arc. 'Inflammatory response' is slowere.g., swelling post-burn, not instant. 'General adaptation syndrome' is chronice.g., not a split-second act. 'Fight-or-flight response' is systemice.g., adrenaline, not localized reflex. A nurse knowse.g., C-fibers fire, no brain neededreflex saves from harm, unlike GAS's stages. Choice B is the correct, rapid mechanism.