ATI RN
Fundamental Concepts and Skills for Nursing Test Bank Questions
Question 1 of 5
The nurse caring is caring for a client who is recovering from a hysterectomy. Which clinical manifestation supports that the client is experiencing a pulmonary embolism (PE)?
Correct Answer: C
Rationale: Pulmonary embolism (PE) is a serious condition where a blood clot travels to the lungs and blocks blood flow, which can be life-threatening. Common clinical manifestations of PE include sudden onset of dyspnea (difficulty breathing), chest pain (sharp, stabbing pain that may worsen with deep breaths), tachypnea (rapid breathing), tachycardia (rapid heart rate), and possibly cough or hemoptysis (coughing up blood). In the context of a client recovering from a hysterectomy, it is crucial to recognize the signs of PE as early intervention is essential to prevent serious complications. Nausea, decreased urine output, and activity intolerance are not typical clinical manifestations of a pulmonary embolism and should not be the primary focus when suspecting a PE in this scenario.
Question 2 of 5
A patient is being treated for a condition where the pituitary gland is producing an increased amount of antidiuretic hormone (ADH). What finding would the nurse most likely assess in this patient?
Correct Answer: B
Rationale: An increased amount of antidiuretic hormone (ADH) leads to the condition known as syndrome of inappropriate antidiuretic hormone (SIADH). This condition results in the kidneys absorbing more water, which leads to decreased urine output (oliguria) and concentrated urine. The increased ADH levels cause the body to retain fluid, leading to a decrease in urine output and potential complications such as hyponatremia (low sodium levels), which can be harmful. Increased facial hair growth or decreased testosterone production are not directly related to an overproduction of ADH.
Question 3 of 5
The nurse suspects that an older female patient has a health problem affecting the renal system. Which statement did the patient make that caused the nurse to come to this conclusion?
Correct Answer: D
Rationale: The statement "My doctor told me I have a slight amount of protein in my urine" suggests that the patient has proteinuria, which is a condition where abnormal amounts of protein are found in the urine. Proteinuria can be an indication of a health problem affecting the renal system, such as kidney disease or dysfunction. This made the nurse suspect that the older female patient may have an issue with her renal system. Statements A, B, and C are common experiences related to urinary habits but do not specifically point towards a renal health problem like proteinuria does.
Question 4 of 5
An older patient with heart failure is prescribed digoxin (Lanoxin) 125 mg by mouth three times a week. What action should the nurse take regarding this prescribed medication?
Correct Answer: C
Rationale: For an older patient with heart failure prescribed digoxin (Lanoxin) 125 mcg by mouth three times a week, the nurse should administer the drug as prescribed while monitoring for manifestations of toxicity. Digoxin is a medication commonly used in heart failure, but it has a narrow therapeutic index, meaning that the difference between a therapeutic dose and a toxic dose is small. Older patients are more susceptible to digoxin toxicity due to age-related changes in pharmacokinetics and pharmacodynamics, as well as potential comorbidities. Therefore, close monitoring for signs and symptoms of digoxin toxicity, such as nausea, vomiting, visual disturbances, and cardiac arrhythmias, is essential. It is important for the nurse to be vigilant for any early signs of toxicity and communicate any concerns to the healthcare provider promptly.
Question 5 of 5
The nurse is teaching a patient self-care approaches for a sprained ankle. For which reason should the nurse emphasize the use of ice after this type of injury?
Correct Answer: D
Rationale: The nurse should emphasize the use of ice after a sprained ankle because it helps decrease the diameter of blood vessels. By applying ice to the injured area, vasoconstriction occurs, which means the blood vessels constrict and become narrower. This helps reduce swelling, inflammation, and pain associated with the injury. Cold therapy through the application of ice is a common approach used in the immediate management of sprains and strains to promote healing and alleviate discomfort.