ATI RN
test bank foundations of nursing Questions
Question 1 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 2 of 5
When teaching patients about the risk factors of cervical cancer, what would the nurse identify as the most important risk factor?
Correct Answer: B
Rationale: The correct answer is B: Human papillomavirus (HPV). HPV is the most important risk factor for cervical cancer as it is responsible for almost all cases. Step 1: HPV infection can lead to changes in cervical cells, increasing the risk of cancer. Step 2: Early detection and vaccination against HPV can prevent cervical cancer. Step 3: Other factors like late childbearing, postmenopausal bleeding, and tobacco use may be associated with increased risk but are not as directly linked to cervical cancer development.
Question 3 of 5
The nurse is assessing a patient with multiple sclerosis who is demonstrating involuntary, rhythmic eye movements. What term will the nurse use when documenting these eye movements?
Correct Answer: C
Rationale: The correct term for the involuntary, rhythmic eye movements seen in the patient with multiple sclerosis is nystagmus. Nystagmus is a condition characterized by repetitive, uncontrolled eye movements that can be horizontal, vertical, or rotary. In multiple sclerosis, nystagmus can occur due to damage to the nerves that control eye movement. Vertigo (choice A) is a sensation of spinning or dizziness, not related to eye movements. Tinnitus (choice B) is a perception of noise or ringing in the ears. Astigmatism (choice D) is a refractive error of the eye, not related to involuntary eye movements.
Question 4 of 5
A patient with preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is a
Correct Answer: C
Rationale: The correct answer is C: anticonvulsant. Magnesium sulfate is used in the treatment of preeclampsia to prevent seizures, making it an anticonvulsant. It works by reducing neuromuscular excitability and stabilizing nerve cell membranes. Choice A (diuretic) is incorrect because magnesium sulfate does not primarily promote diuresis. Choice B (tocolytic) is incorrect as it does not inhibit uterine contractions. Choice D (antihypertensive) is incorrect because although magnesium sulfate can help lower blood pressure in preeclampsia, its primary indication in this case is for seizure prophylaxis.
Question 5 of 5
A patient on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in patients at risk for thrombocytopenia?
Correct Answer: C
Rationale: The correct answer is C: Epistaxis (nose bleed). Thrombocytopenia is a condition characterized by a low platelet count, leading to impaired blood clotting and an increased risk of bleeding. Epistaxis is a common symptom of thrombocytopenia due to the lack of platelets to aid in clot formation. Assessing for epistaxis in patients receiving carmustine is crucial to monitor and manage potential bleeding complications. Choices A, B, and D are incorrect as they are not directly associated with thrombocytopenia.
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