ATI RN
foundations of nursing test bank Questions
Question 1 of 9
A woman is being treated for a tumor of the left breast. If the patient and her physician opt for prophylactic treatment, the nurse should prepare the woman for what intervention?
Correct Answer: D
Rationale: The correct answer is D: Bilateral mastectomy. This intervention involves removing both breasts to reduce the risk of developing breast cancer in the future. For a woman with a history of breast cancer in one breast, opting for bilateral mastectomy can significantly decrease the likelihood of cancer recurrence. This proactive approach is often recommended for individuals with a high risk of developing breast cancer. Explanation for why the other choices are incorrect: A: More aggressive chemotherapy - Chemotherapy is typically used to treat existing cancer cells, not as a prophylactic measure to prevent cancer. B: Left mastectomy - This option only removes the affected breast, not addressing the risk of cancer developing in the other breast. C: Radiation therapy - While radiation therapy can be used as part of the treatment for breast cancer, it is not a prophylactic measure to prevent future cancer development in the contralateral breast.
Question 2 of 9
A nurse who sits on the hospitals ethics committee is reviewing a complex case that has many of the hallmarks of assisted suicide. Which of the following would be an example of assisted suicide?
Correct Answer: A
Rationale: The correct answer is A because administering a lethal dose of medication to a patient whose death is imminent directly causes the patient's death, constituting assisted suicide. This action is intentional and aims to end the patient's life. In contrast, choices B, C, and D do not involve intentionally causing the patient's death. Choice B involves a medication error but not with the intent to end the patient's life. Choice C respects the patient's autonomy in refusing treatment. Choice D honors the patient's wishes for end-of-life care. Thus, only choice A aligns with the definition of assisted suicide.
Question 3 of 9
A patient with preeclampsia is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate
Correct Answer: D
Rationale: The correct answer is D because the patient's symptoms of pounding headache, visual changes, and epigastric pain are classic signs of worsening preeclampsia, indicating a significant increase in blood pressure and potential progression to eclampsia (seizures). Immediate medical intervention is crucial to prevent complications. A: Gastrointestinal upset does not explain the combination of symptoms presented. B: Magnesium sulfate is used to prevent seizures in preeclampsia but does not cause these specific symptoms. C: Anxiety does not typically present with the specific physical symptoms mentioned.
Question 4 of 9
A patient with HIV has a nursing diagnosis of Risk for Impaired Skin Integrity. What nursing intervention best addresses this risk?
Correct Answer: A
Rationale: The correct answer is A: Utilize a pressure-reducing mattress. This intervention is crucial for preventing pressure ulcers in patients at risk for impaired skin integrity, such as those with HIV. By redistributing pressure, a pressure-reducing mattress helps to alleviate pressure on vulnerable areas, reducing the risk of skin breakdown. Limiting physical activity (B) can lead to muscle atrophy and worsen skin integrity. Applying antibiotic ointment (C) may not address the root cause of skin breakdown. Avoiding synthetic fabrics (D) may be helpful in some cases, but it is not as effective as using a pressure-reducing mattress.
Question 5 of 9
A student nurse is doing clinical hours at an OB/GYN clinic. The student is helping to develop a plan of care for a patient with gonorrhea who has presented at the clinic. The student should include which of the following in the care plan for this patient?
Correct Answer: D
Rationale: Correct Answer: D - The patient should also be treated for chlamydia. Rationale: 1. Gonorrhea and chlamydia often coexist, so it is crucial to treat both infections to prevent complications. 2. Treating only gonorrhea may not fully resolve the patient's symptoms or prevent reinfection. 3. Dual therapy for gonorrhea and chlamydia is recommended to ensure optimal care for the patient. Summary of Incorrect Choices: A: The patient may benefit from oral contraceptives - This is not directly related to the treatment of gonorrhea. B: The patient must avoid use of tampons - This is not a standard recommendation for managing gonorrhea. C: The patient is susceptible to urinary incontinence - This is not a typical complication of gonorrhea.
Question 6 of 9
A 22-year-old male is being discharged home after surgery for testicular cancer. The patient is scheduled to begin chemotherapy in 2 weeks. The patient tells the nurse that he doesnt think he can take weeks or months of chemotherapy, stating that he has researched the adverse effects online. What is the most appropriate nursing action for this patient at this time?
Correct Answer: A
Rationale: Correct Answer: A. Provide empathy and encouragement in an effort to foster a positive outlook. Rationale: 1. Empathy and encouragement are essential in establishing rapport and trust with the patient. 2. By fostering a positive outlook, the nurse can help alleviate the patient's anxiety and fears. 3. Encouraging a positive mindset can improve the patient's adherence to treatment. 4. It is important to address the patient's concerns and provide support rather than dismissing them. Summary: B: Telling the patient it is his decision may not address his emotional needs and could lead to further distress. C: Reporting the patient's statement to his support system may breach confidentiality and undermine trust. D: Referring the patient to social work may be premature without first addressing the patient's emotional concerns directly.
Question 7 of 9
A 31-year-old patient has returned to the post-surgical unit following a hysterectomy. The patients care plan addresses the risk of hemorrhage. How should the nurse best monitor the patients postoperative blood loss?
Correct Answer: B
Rationale: The correct answer is B: Count and inspect each perineal pad that the patient uses. This method directly measures postoperative blood loss and allows for accurate monitoring. It provides quantitative data to assess the severity of hemorrhage. A: Having the patient void and have bowel movements using a commode rather than toilet does not directly measure blood loss and may not provide accurate monitoring. C: Swabbing the patient's perineum for the presence of blood is not as accurate as directly counting and inspecting perineal pads. D: Leaving the patient's perineum open to air does not provide a method for quantifying blood loss and may not be as reliable as inspecting perineal pads.
Question 8 of 9
The nurse is concerned about pulmonary aspiration when providing the patient with an intermittent tube feeding. Which action is thepriority?
Correct Answer: B
Rationale: The correct answer is B because verifying tube placement before feeding is essential to prevent pulmonary aspiration. If the tube is not correctly positioned in the stomach, there is a risk of feeding going into the lungs. Observing the color of gastric contents (A) may not always indicate correct placement. Adding blue food coloring (C) is unnecessary and could cause confusion. Running the formula over 12 hours (D) does not address the risk of pulmonary aspiration and does not ensure proper tube placement.
Question 9 of 9
The nurse is performing an initial assessment of an older adult resident who has just relocated to the long-term care facility. During the nurses interview with the patient, she admits that she drinks around 20 ounces of vodka every evening. What types of cancer does this put her at risk for? Select all that apply.
Correct Answer: D
Rationale: The correct answer is D: Esophageal cancer. Alcohol consumption is a known risk factor for developing esophageal cancer. Ethanol, a component of alcohol, can damage the cells lining the esophagus and lead to the development of cancer over time. Incorrect choices: A: Malignant melanoma - Alcohol consumption is not directly linked to the development of malignant melanoma, a type of skin cancer. B: Brain cancer - There is no strong evidence linking alcohol consumption to an increased risk of brain cancer. C: Breast cancer - While excessive alcohol consumption is a risk factor for breast cancer, the primary association is with esophageal cancer in this case. E: Liver cancer - While alcohol abuse can lead to liver damage and increase the risk of liver cancer, the question specifies the types of cancer the patient is at risk for due to alcohol consumption, not the general risks associated with alcohol abuse.