Questions 9

ATI RN

ATI RN Test Bank

hesi health assessment test bank 2023 Questions

Question 1 of 5

The mother of a 16-month-old toddler tells the nurse that her daughter has an earache. Which of the following would be an appropriate response?

Correct Answer: D

Rationale: The correct response is D because it encourages the mother to provide specific information about the toddler's behavior indicating pain. This helps the nurse assess the severity and nature of the earache accurately. Options A and C are dismissive and may overlook a potential health issue. Option B suggests immediate action without gathering information first, which may not be necessary.

Question 2 of 5

What is the priority action for a client with an open chest wound?

Correct Answer: A

Rationale: The correct answer is A: Apply a sterile dressing. Firstly, cover the wound with a sterile occlusive dressing to prevent air from entering the pleural space, reducing the risk of tension pneumothorax. This also helps to prevent infection and further complications. Administering morphine (B) or nitroglycerin (D) is not the priority in this situation as managing the chest wound is crucial. Applying an airtight dressing (C) may lead to tension pneumothorax if not done properly. Therefore, the immediate action should be to apply a sterile dressing to stabilize the wound and prevent further complications.

Question 3 of 5

A female patient does not speak English well, and the nurse needs to choose an interpreter. Which of the following would be the most appropriate choice?

Correct Answer: A

Rationale: The correct answer is A: A trained interpreter. Choosing a trained interpreter ensures accurate communication and confidentiality. Professional interpreters have the necessary language skills and cultural competence to facilitate effective communication between the healthcare provider and the patient. Using a family member (choices B and C) may compromise confidentiality and accuracy due to potential bias or lack of professional training. Similarly, selecting a volunteer university student (choice D) may result in misinterpretation or breach of privacy as they may not have the same level of expertise as a trained interpreter. Ultimately, the most appropriate choice is a trained interpreter to ensure clear and accurate communication while respecting the patient's privacy and dignity.

Question 4 of 5

A woman has come to the clinic to seek help for a substance use problem. She admits to using cocaine just before coming to the clinic. Which of the following describes what the nurse may find when examining this woman?

Correct Answer: A

Rationale: The correct answer is A. Cocaine is a stimulant drug that typically leads to symptoms such as dilated pupils, pacing, and psychomotor agitation. Dilated pupils occur due to increased catecholamines. Pacing and psychomotor agitation are common behaviors associated with cocaine use. Unsteady gait and aggressiveness (Option B) are more characteristic of alcohol intoxication. Pupil constriction, lethargy, apathy, and dysphoria (Option C) are typical symptoms of opioid use. Constricted pupils, euphoria, and decreased temperature (Option D) are more indicative of opioid use as well.

Question 5 of 5

Which nursing measure is most appropriate to meet the expected outcome of positive body image in a client with Kawasaki disease?

Correct Answer: C

Rationale: The correct answer is C: explaining progression of the disease to the client and family. This measure helps the client and family understand the disease, leading to better coping and acceptance, thus promoting a positive body image. Administering immune globulin (A) is not directly related to body image. Assessing extremities (B) and heart sounds (D) are important for monitoring the disease but do not directly impact body image.

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