ATI RN
Adult Health Nursing Test Bank Questions
Question 1 of 9
The nurse assesses the uterine fundus of the mother. Which part of the abdomen will the nurse begin?
Correct Answer: C
Rationale: The correct answer is C: Umbilicus. The nurse begins assessing the uterine fundus at the level of the umbilicus as it is a standard reference point for postpartum fundal height measurement. This location allows for consistency and accuracy in tracking the descent of the uterus back into the pelvic cavity. Starting at the umbilicus also helps in monitoring the involution process and prevents potential errors in fundal height assessment. Symphysis pubis (A) is too low and not typically used as a reference point for uterine fundal assessment. Midline (B) is vague and does not provide a specific anatomical landmark. Sides of the abdomen (D) do not give a standardized starting point for measuring the uterine fundus, leading to potential variability in assessment.
Question 2 of 9
The nurse specialist explains that chemotherapyis extremely toxic to the bone marrow and the patient may develop thrombocytopenia. What is the priority goal of the nurse? To take precautions to control _______.
Correct Answer: A
Rationale: The correct answer is A: Bleeding. Chemotherapy can lead to low platelet counts (thrombocytopenia), increasing the risk of bleeding. The priority goal of the nurse is to prevent bleeding by taking precautions such as avoiding invasive procedures, using soft toothbrushes, and monitoring for signs of bleeding. Infection (B) is important but not the priority as bleeding can be life-threatening. Hypotension (C) is not directly related to thrombocytopenia. Diarrhea (D) is a potential side effect of chemotherapy but is not the priority when considering thrombocytopenia.
Question 3 of 9
Norse Sophie checks the gauge of the patient ' s intravenous catheter. Which is the smallest gauge catheter that the nurse can use to administer blood?
Correct Answer: B
Rationale: The correct answer is B: 20-Gauge. The smaller the gauge number, the larger the diameter of the catheter. Blood transfusions typically require a larger catheter size to prevent hemolysis and ensure proper flow. A 20-Gauge catheter is larger than 22-Gauge, 18-Gauge, and 12-Gauge, making it suitable for administering blood. 22-Gauge is too small and can cause hemolysis, 18-Gauge is smaller than the recommended size for blood transfusions, and 12-Gauge is too large and can cause damage to the vein.
Question 4 of 9
Lillian complains of unbearable pain. Which of the following characteristics axe EMPHASIZED in a culturally sensitive nursing Care? (Select all that apply) I The expression of pain is affected by learned behavior II. Physiologically, all individuals experience pain in a similar manner, III.. Some Asian people has high response to pain medications IV. Patients should be assessed for pain regardless of overt symptomatology.
Correct Answer: C
Rationale: Step-by-step rationale for the correct answer (C: I and II): 1. Choice I (The expression of pain is affected by learned behavior) is correct because cultural beliefs and upbringing influence how individuals express and perceive pain. 2. Choice II (Physiologically, all individuals experience pain in a similar manner) is correct because pain perception is largely influenced by biological factors that are universal. 3. Choice III (Some Asian people have a high response to pain medications) is incorrect as it focuses on a specific cultural group, which is not a general characteristic emphasized in culturally sensitive care. 4. Choice IV (Patients should be assessed for pain regardless of overt symptomatology) is incorrect as it is not specifically related to cultural sensitivity in pain management.
Question 5 of 9
The PRIORITY nursing objective when caring a patient with a tracheostomy is _________.
Correct Answer: B
Rationale: The correct answer is B: To provide a patent airway. When caring for a patient with a tracheostomy, ensuring a clear and unobstructed airway is the top priority to maintain adequate oxygenation and ventilation. This involves suctioning, maintaining proper tube placement, and monitoring for any signs of respiratory distress. Choices A, C, and D are incorrect as they do not address the immediate need for airway management, which is crucial for the patient's safety and well-being.
Question 6 of 9
During surgery, the nurse notices that the patient's blood pressure is trending higher than the baseline. What action should the nurse take?
Correct Answer: C
Rationale: The correct answer is C: Notify the anesthesia provider for further assessment. This is the most appropriate action because an anesthesia provider is trained to assess and manage changes in blood pressure during surgery. Administering antihypertensive medication (A) without proper assessment can be dangerous. Documenting the readings (B) is important but not the immediate action. Continuing to monitor closely (D) is necessary but notifying the anesthesia provider for further assessment should be the priority.
Question 7 of 9
For the past 6 months, several nurses are resigning. Some have verbalized in the exit interview that there are not happy anymore. Which of the following descriptions manifest BEST, a nurse who has job satisfaction?
Correct Answer: B
Rationale: The correct answer is B because an empowered nurse feels in control and valued, leading to job satisfaction. Enthusiasm shows motivation and engagement with their work. Being ethical indicates a commitment to moral principles, contributing to a sense of fulfillment. Choice A is incorrect as competitiveness and self-centeredness do not necessarily equate to job satisfaction. Euphoria may not be a sustainable indicator of satisfaction. Choice C is incorrect because being a loner and egoistic are not traits associated with job satisfaction. Reactivity may suggest a lack of control or frustration. Choice D is incorrect as being outgoing and competitive might not directly translate to job satisfaction. Sensitivity alone does not guarantee satisfaction in the workplace.
Question 8 of 9
When patient record reach the Medical Records, the assigned staff will _____.
Correct Answer: C
Rationale: The correct answer is C because checking the completeness of the charting by doctors and nurses ensures that all necessary information is accurately documented, facilitating proper patient care and treatment. This step helps identify any missing or incorrect information that may impact patient safety. A: Storing the charts in respective shelves is a routine task that does not involve verifying the accuracy or completeness of the information. B: Separating medico-legal charts is important but does not directly address the completeness of charting by doctors and nurses. D: Binding the charts immediately is not necessary before ensuring the completeness and accuracy of the information documented.
Question 9 of 9
While patient Sarah is confined in the hospital, the safety measure to be observed by the nurses is prevention from fall. This is brought about by the patient being prone to fracture as a result of________.
Correct Answer: B
Rationale: The correct answer is B: osteoporosis. Osteoporosis is a condition characterized by weakened bones, making individuals more susceptible to fractures, especially with minor trauma or falls. In the context of a patient prone to fractures, nurses should be particularly cautious about fall prevention. A: The aging process alone does not necessarily lead to an increased risk of fractures. While aging is a risk factor for osteoporosis, it is not the direct cause of fractures in this case. C: Changes in vision can contribute to an increased risk of falls, but it is not the primary reason for the patient being prone to fractures in this scenario. D: Hematologic conditions may affect bone health, but they are not typically the primary cause of increased fracture risk in patients.