ATI RN
Basic Care Needs of Patients Questions
Question 1 of 5
An 85-year-old male patient has been bedridden for two weeks. Which of the following complaints by the patient indicates to the nurse that he is developing a complication of immobility?
Correct Answer: A
Rationale: Stiffness of a joint may indicate the beginning of a contracture and/or early muscle atrophy. Soreness of the gums is not related to immobility. Short-term memory loss is not related to immobility. Decreased appetite is unlikely to be related to immobility.
Question 2 of 5
The patient has presented to the ambulatory surgery center to have a colonoscopy. The patient is scheduled to receive moderate sedation (conscious sedation) during the procedure. How will the nurse interpret this information?
Correct Answer: B
Rationale: The correct interpretation of moderate sedation is that it requires a depressed level of consciousness. During moderate sedation, the patient is in a state where they can respond to verbal commands and tactile stimulation, but their level of consciousness is decreased. This allows the patient to be comfortable and cooperative during the procedure. Choice A is incorrect because moderate sedation does not result in loss of sensation in a specific area of the body. Choice C is incorrect because the fact that the procedure is performed on an outpatient basis is not directly related to the type of sedation used. Choice D is incorrect as moderate sedation does not necessarily require the patient to be immobile; they may still be able to move and reposition themselves to some extent.
Question 3 of 5
The nurse is assessing a postoperative patient with a history of obstructive sleep apnea for airway obstruction. Which assessment finding will best alert the nurse to this complication?
Correct Answer: A
Rationale: The correct answer is A: Drop in pulse oximetry readings. In a postoperative patient with a history of obstructive sleep apnea, airway obstruction can lead to decreased oxygen levels, indicated by a drop in pulse oximetry readings. This is the best assessment finding to alert the nurse to this complication because it directly reflects the patient's oxygenation status. Moaning with reports of pain (B) and shallow respirations (C) may indicate pain or respiratory distress but do not specifically point towards airway obstruction. Disorientation (D) can be a sign of various issues, not specifically related to airway obstruction.
Question 4 of 5
An elderly patient is found unconscious and unresponsive. His heart rate is 30 beats per minute, blood pressure is 70/40 mmHg, and his skin is pale and cool. Which intervention should be performed first?
Correct Answer: B
Rationale: The correct answer is B: Establish transcutaneous pacing. This intervention is vital to address the patient's symptomatic bradycardia and hemodynamic instability. Transcutaneous pacing will quickly increase the heart rate and improve perfusion. Atropine may be used if pacing is not immediately available. Administering dopamine or a fluid bolus are not the first-line interventions in this scenario. Dopamine would take time to titrate and may not be as effective as pacing in rapidly stabilizing the patient. Providing a fluid bolus may worsen the situation by increasing the intravascular volume without addressing the underlying bradycardia.
Question 5 of 5
You are on scene at a motor vehicle accident, and your 20-year-old patient is entrapped. He is unconscious, unresponsive, and has a palpable carotid pulse that is weak and thready. His breathing is slow and shallow at four times a minute with equal chest wall expansion. There are no obvious deformity injuries or hemorrhage noted. Fire department on-scene has stabilized the vehicle and provided you and your partner a relatively safe environment to manage the entrapped patient. However, access is limited to the seated patient, and extrication is expected to take another twenty minutes. After having your partner maintain cervical spine stabilization, which of the following would be the best choice for securing the patient's airway?
Correct Answer: C
Rationale: The correct answer is C: Intubate the patient using the blind orotracheal intubation technique to maintain in-line mobilization of the spine, then assist ventilation. In this scenario, the patient is entrapped with limited access and expected extrication time of 20 minutes. Given the patient's unconsciousness, unresponsiveness, weak carotid pulse, and slow, shallow breathing, securing the airway is crucial to ensure adequate oxygenation and ventilation. Intubating the patient using the blind orotracheal technique allows for maintaining in-line mobilization of the spine, reducing the risk of further spinal injury during the extrication process. This approach provides a more definitive airway management compared to nasal airway insertion or bag-valve mask ventilation. Nasotracheal intubation (choice B) may not be feasible due to limited access and potential for further injury. Using a King LTD (choice D) is not recommended in this situation as it does not provide the same