ATI RN
test bank foundations of nursing Questions
Question 1 of 5
The nurse is caring for a patient who has just been told that her ovarian cancer is terminal and that no curative options remain. What would be the priority nursing care for this patient at this time?
Correct Answer: A
Rationale: The correct answer is A: Provide emotional support to the patient and her family. This is the priority as the patient has received devastating news and needs immediate support. Emotional support can help the patient cope with the diagnosis, express feelings, and make decisions. B: Implementing distraction techniques may not address the patient's emotional needs in this critical situation. C: Offering to inform the family of the diagnosis is important but not the priority at this moment. D: Teaching about maintaining a positive attitude may not be appropriate as the patient is facing a terminal illness.
Question 2 of 5
A 45-year-old woman comes into the health clinic for her annual check-up. She mentions to the nurse that she has noticed dimpling of the right breast that has occurred in a few months. What assessment would be most appropriate for the nurse to make?
Correct Answer: B
Rationale: The correct answer is B. Palpating the area for a breast mass is the most appropriate assessment in this scenario as dimpling of the breast can be a sign of underlying breast abnormalities such as a mass or tumor. By palpating the area, the nurse can determine if there is a lump or any other irregularity that may require further investigation. Choice A is incorrect because evaluating the patient's milk production is not relevant to the presenting symptom of breast dimpling. Choice C is incorrect as assessing the patient's knowledge of breast cancer does not address the immediate need for a physical assessment of the breast dimpling. Choice D is incorrect because assuming that the dimpling is just an age-related change without further assessment could delay potential diagnosis and treatment of a serious condition.
Question 3 of 5
During a recent visit to the clinic a woman presents with erythema of the nipple and areola on the right breast. She states this started several weeks ago and she was fearful of what would be found. The nurse should promptly refer the patient to her primary care provider because the patients signs and symptoms are suggestive of what health problem?
Correct Answer: C
Rationale: Rationale: 1. Erythema of nipple/areola in one breast can be a sign of Paget's disease, a rare form of breast cancer. 2. Paget's disease may also present with itching, tingling, or a burning sensation in the affected area. 3. Referring the patient promptly is crucial for early detection and appropriate management. 4. Peau d'orange (A) is a sign of advanced breast cancer, not typically presenting with erythema alone. 5. Nipple inversion (B) may be benign or related to other conditions, not typically presenting with erythema. 6. Acute mastitis (D) presents with breast pain, warmth, swelling, and fever, but not typically with isolated erythema of the nipple/areola.
Question 4 of 5
The nurse is caring for a patient who has just had a radical mastectomy and axillary node dissection. When providing patient education regarding rehabilitation, what should the nurse recommend?
Correct Answer: C
Rationale: The correct answer is C: Avoid lifting objects heavier than 10 pounds. This recommendation is crucial post-mastectomy as it helps prevent lymphedema and promotes healing without causing strain on the surgical site. Lifting heavy objects can lead to complications such as lymphedema or disruption of the healing process. Options A, B, and D are incorrect as avoiding exercise of the arm for 2 months may lead to stiffness and reduced range of motion, keeping cuticles clipped neatly does not directly affect rehabilitation, and using a sling is not necessary unless specifically advised by the healthcare provider.
Question 5 of 5
A patient has presented for her annual mammogram. The patient voices concerns related to exposure to radiation. What should the nurse teach the patient about a mammogram?
Correct Answer: A
Rationale: Step 1: Mammograms use low-dose X-rays to create images of the breast tissue. Step 2: The radiation exposure in a mammogram is minimal and considered safe. Step 3: Choice A is correct as it states that mammograms do not use radiation, which is accurate. Step 4: Other choices are incorrect because B wrongly implies that annual mammograms are safe due to low radiation levels, C is incorrect as radiation effects can accumulate over time, and D is incorrect as the amount of radiation in a mammogram is much lower than an hour of sunlight.