ATI RN
Transcultural Concepts in Nursing Care Test Bank Questions
Question 1 of 5
The nurse identifies the diagnosis of Deficient Fluid Volume as appropriate for a patient with a nasogastric tube for gastric decompression. Which actions should the nurse perform to support this diagnosis? Select all that apply.
Correct Answer: A
Rationale: A. Measuring abdominal girth every 4 to 8 hours is important to monitor for signs of fluid accumulation in the abdominal cavity, indicating potential fluid volume deficit.
Question 2 of 5
The nurse is providing discharge teaching to a client recovering from deep venous thrombosis (DVT). Which instructions are appropriate for the nurse to include in the teaching session? Select all that apply.
Correct Answer: A
Rationale: A. Avoid crossing the legs: Crossing the legs can impede blood flow and increase the risk of developing blood clots, so it is important for the client recovering from DVT to avoid this position.
Question 3 of 5
The nurse is assessing muscle strength. What should the nurse ask the patient to do to assess facial muscle strength?
Correct Answer: A
Rationale: Asking the patient to clench their teeth is a common way to assess muscle strength in the face, particularly the muscles involved in the jaw. Clenching the teeth engages the muscles responsible for this action, such as the masseter muscle. Assessing the ability to clench the teeth provides insight into the strength and function of these facial muscles.
Question 4 of 5
Which theory of learning holds that knowledge acquisition is the ongoing assimilation and accommodation of new experiences and interpretations?
Correct Answer: A
Rationale: The theory of constructivism holds that knowledge acquisition is the ongoing assimilation and accommodation of new experiences and interpretations. This theory emphasizes that learners actively construct their knowledge and understanding of the world through their experiences and interactions. In constructivism, learning is seen as a process of building upon prior knowledge, rather than passively receiving information. Learners are encouraged to explore, question, and make sense of new information based on their existing beliefs and experiences. Therefore, the constructivist theory aligns with the idea that learning involves the assimilation and accommodation of new experiences and interpretations.
Question 5 of 5
A school-age client with a history of multiple allergies is prescribed epinephrine (EpiPen™) for prevention of anaphylactic shock. The client's mother says to the nurse, "I thought shock was about heart failure." Which response by the nurse is the most appropriate?
Correct Answer: A
Rationale: The most appropriate response by the nurse is Option A, "Allergic response is the most fatal type of shock; other types involve loss of blood, heart failure, and liver failure." This response is accurate because anaphylactic shock, which is caused by severe allergic reactions, can be life-threatening if not treated promptly with epinephrine (EpiPen™). While heart failure is a serious type of shock, anaphylactic shock is specifically related to severe allergic reactions and not heart failure. The nurse's response educates the mother about the seriousness of anaphylactic shock in relation to allergic responses and highlights that other types of shock can involve different organ system failures.
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