It is 10 o'clock of your watch. The client asks, "What time is it?" The nurse's appropriate response is:

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Question 1 of 5

It is 10 o'clock of your watch. The client asks, "What time is it?" The nurse's appropriate response is:

Correct Answer: B

Rationale: The nurse's appropriate response is to provide the requested information clearly and directly. In this case, the client asked for the time, so the best response is to say "It is 10 o'clock" to answer their question promptly. Options A, C, and D do not address the client's question and may be perceived as dismissive or unhelpful.

Question 2 of 5

The 5's strategy to prevent dengue infection includes the following, EXCEPT

Correct Answer: B

Rationale: The 5's strategy to prevent dengue infection includes Search and Destroy mosquito breeding places, seek early consultation at the nearest health care facility, say no to fogging spraying, and misting in hot spot areas. While using mosquito repellent on exposed skin is a common preventive measure against mosquito bites, applying it all over your body is not included in the official 5's strategy for dengue prevention. The focus of the 5's strategy is on eliminating mosquito breeding sites, seeking medical advice early in case of symptoms, and avoiding certain mosquito control methods like fogging in hot spot areas.

Question 3 of 5

Mr. C is an older patient with a known history of peripheral vascular disease. The nurse places a heating pad directly on the patient's lower leg to relieve muscle spasms. The heating pad causes a burn, the area becomes infected, and the patient eventually must have a skin graft. This is an example of which of the following?

Correct Answer: D

Rationale: Negligence refers to the failure to take proper care in doing something. In this scenario, the nurse failed to exercise the standard of care expected in placing a heating pad directly on Mr. C's lower leg, knowing his history of peripheral vascular disease. This failure led to a burn and subsequent infection that required a skin graft for treatment. The actions of the nurse were negligent as they did not meet the expected standard of care, resulting in harm to the patient. This situation does not fit the definition of assault, malpractice, or vicarious liability, making negligence the most appropriate choice.

Question 4 of 5

A patient with chronic kidney disease presents with metabolic acidosis. Which compensatory mechanism is the body most likely to employ to normalize pH?

Correct Answer: B

Rationale: In a patient with chronic kidney disease presenting with metabolic acidosis, the compensatory mechanism the body is most likely to employ to normalize pH is increased bicarbonate reabsorption in the kidneys. The kidneys play a crucial role in maintaining acid-base balance by regulating bicarbonate levels in the blood. In metabolic acidosis, there is an excess of non-volatile acids in the body, leading to a decrease in blood pH. To compensate for this acidosis, the kidneys increase the reabsorption of filtered bicarbonate ions from the renal tubules back into the blood. This process helps to raise the bicarbonate levels in the blood, which in turn helps to neutralize excess hydrogen ions and restore the blood pH towards normal levels. Hyperventilation (A) is a compensatory mechanism for respiratory acidosis, not metabolic acidosis. Increased renal excretion of hydrogen ions (C) and decreased renal excretion of bicarbonate ions

Question 5 of 5

A patient with a history of coronary artery disease is prescribed aspirin for secondary prevention. Which adverse effect is a potential concern with long-term aspirin therapy?

Correct Answer: B

Rationale: Long-term aspirin therapy, especially at higher doses, can increase the risk of gastrointestinal bleeding. Aspirin irreversibly inhibits cyclooxygenase enzyme, which is essential for the production of prostaglandins involved in mucosal protection of the gastrointestinal tract. Without these protective prostaglandins, the stomach lining becomes more susceptible to damage from gastric acid, leading to potential ulcer formation and bleeding. Patients with a history of coronary artery disease may be on aspirin for secondary prevention, and it is crucial to monitor for signs of bleeding such as black, tarry stools or abdominal pain. The benefits of aspirin in preventing cardiovascular events need to be weighed against the risk of adverse effects like gastrointestinal bleeding, especially in patients on long-term therapy.

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