ATI RN
test bank foundations of nursing Questions
Question 1 of 9
A patient with metastatic cancer has developed trigeminal neuralgia and is taking carbamazepine (Tegretol) for pain relief. What principle applies to the administration of this medication?
Correct Answer: B
Rationale: The correct answer is B: The patient should be monitored for bone marrow depression. Carbamazepine can cause bone marrow suppression, leading to decreased production of blood cells. Monitoring blood counts is crucial to detect this adverse effect early. Choice A is incorrect as Tegretol can have serious adverse effects, including bone marrow depression. Choice C is incorrect as the main side effects of carbamazepine are related to the central nervous system, not renal dysfunction. Choice D is incorrect as medications like carbamazepine should be started at a low dose and gradually titrated up to minimize side effects.
Question 2 of 9
A smiling patient angrily states, “I will notcough and deep breathe.” How will the nurse interpret this finding?
Correct Answer: C
Rationale: The correct answer is C because the patient's affect, which refers to their emotional expression, is inappropriate. The patient is smiling while expressing anger, which is a contradiction. This inconsistency indicates a possible underlying issue such as emotional distress or confusion. Choice A is incorrect because the issue is not about the patient's understanding of the term "cough and deep breathe." Choice B is incorrect as there is no mention of personal space violation. Choice D is incorrect as the issue is not related to the patient's vocabulary but rather their emotional expression.
Question 3 of 9
A nurse is describing the purposes of a healthcare record to a group of nursing students. Which purposes will the nurse include in the teaching session? (Select all thatapply.)
Correct Answer: A
Rationale: The correct answer is A: Communication. Healthcare records are essential for effective communication among healthcare providers to ensure continuity of care. They help convey important information about a patient's condition, treatment plan, and progress. Explanation: 1. Communication: Healthcare records facilitate communication between different healthcare team members, ensuring coordinated and efficient care delivery. 2. Legal documentation: While important, legal documentation is a separate purpose of healthcare records, not directly related to communication. 3. Reimbursement: Healthcare records are used for billing and reimbursement purposes, but this is not directly related to communication. 4. Nursing process: The nursing process involves assessment, diagnosis, planning, implementation, and evaluation of patient care, which is documented in healthcare records. However, this is not a primary purpose related to communication.
Question 4 of 9
A patient has been prescribed sildenafil. What should the nurse teach the patient about this medication?
Correct Answer: A
Rationale: The correct answer is A because sildenafil works by enhancing the effects of nitric oxide, which is released during sexual stimulation to relax the muscles in the penis and increase blood flow for an erection. Therefore, sexual stimulation is necessary for the medication to be effective. Explanation of other choices: B: While sildenafil is typically taken 30 minutes to 4 hours before sexual activity, it does not need to be exactly 1 hour prior. C: Facial flushing and headache are common side effects of sildenafil but do not require immediate reporting unless severe or persistent. D: Sildenafil may cause temporary visual disturbances like changes in color vision, but permanent visual changes are rare.
Question 5 of 9
A nurse is caring for a 33-year-old male who has come to the clinic for a physical examination. He states that he has not had a routine physical in 5 years. During the examination, the physician finds that digital rectal examination (DRE) reveals stoney hardening in the posterior lobe of the prostate gland that is not mobile. The nurse recognizes that the observation typically indicates what?
Correct Answer: C
Rationale: The correct answer is C: Evidence of a more advanced lesion. A stoney hardening in the posterior lobe of the prostate gland that is not mobile is indicative of a more advanced lesion, such as prostate cancer. This finding suggests that the lesion has progressed beyond the early stages. In early prostate cancer, the prostate gland may feel firm but not stoney hard, and the lesion is usually mobile. Metastatic disease would involve spread of the cancer to other parts of the body, which is not evident from the DRE alone. A normal finding would not present as stoney hardening and lack of mobility in the prostate gland during a DRE.
Question 6 of 9
A nurse is caring for an immigrant with low income.Which information should the nurse consider when planning care for this patient?
Correct Answer: B
Rationale: The correct answer is B: There is an increased incidence of disease. Low-income immigrants often face barriers to healthcare access, leading to higher rates of undiagnosed and untreated health conditions. This information is crucial for the nurse to plan appropriate care interventions. Incorrect choices: A: Decreased frequency of morbidity is not accurate as low-income immigrants may experience higher rates of illness due to lack of resources. C: Increased level of health is unlikely in this population due to socioeconomic factors affecting health outcomes. D: Decreased mortality rate is not supported as low-income immigrants may have higher mortality rates due to limited access to healthcare.
Question 7 of 9
An adolescent patients history of skin hyperreactivity and inflammation has been attributed to atopic dermatitis. The nurse should recognize that this patient consequently faces an increased risk of what health problem?
Correct Answer: D
Rationale: The correct answer is D: Asthma. Atopic dermatitis is associated with a heightened immune response and inflammation, which can predispose individuals to developing asthma. Both conditions involve an overactive immune response and can coexist in patients due to shared genetic and environmental factors. Asthma commonly presents alongside atopic dermatitis in individuals with atopic tendencies. Bronchitis (choice A) is a respiratory condition caused by inflammation of the bronchial tubes and is not directly linked to atopic dermatitis. Systemic lupus erythematosus (choice B) and rheumatoid arthritis (choice C) are autoimmune diseases that primarily affect the joints and other organs, but they are not typically associated with atopic dermatitis.
Question 8 of 9
A patient diagnosed with cervical cancer will soon begin a round of radiation therapy. When planning the patients subsequent care, the nurse should prioritize actions with what goal?
Correct Answer: C
Rationale: The correct answer is C: Protecting the safety of the patient, family, and staff. This is the priority when planning care for a patient undergoing radiation therapy due to the potential risks of radiation exposure to others. Ensuring safety involves implementing proper radiation safety protocols, educating the patient and family on safety measures, and providing a safe environment for all. Choices A, B, and D are incorrect. Preventing hemorrhage is important but not the top priority during radiation therapy. Ensuring the patient understands the treatment's purpose is essential but not the immediate priority. Adherence to dietary restrictions is important for overall health but is not the primary focus when prioritizing actions for radiation therapy.
Question 9 of 9
A nurse is caring for a patient who just underwentan intravenous pyelography that revealed a renal calculus obstructing the left ureter. What is the nurse’sfirstpriorityin caring for this patient?
Correct Answer: C
Rationale: The correct answer is C: Monitor the patient for fever, rash, and difficulty breathing. The rationale is as follows: 1. Renal calculus obstruction can lead to complications such as infection, so monitoring for fever is crucial. 2. Rash can indicate an allergic reaction to the contrast dye used in the procedure. 3. Difficulty breathing may signal a severe reaction or complications. Summary: A: Turning the patient on the right side does not directly address the urgent need to monitor for potential complications. B: While fluid intake is important, it is not the immediate priority when the patient is at risk of developing complications. D: Administering narcotic medications may be necessary for pain relief but does not address the potential emergent issues related to the obstruction.