ATI RN
Concepts for Nursing Practice Test Bank Questions
Question 1 of 5
The nurse is evaluating the teaching provided to a patient with acute glomerulonephritis. Which patient action indicates that additional teaching is not necessary?
Correct Answer: B
Rationale: Option B, "Demonstrates care of the vascular access device for dialysis," indicates that the patient understands how to care for their vascular access device, which is important for receiving dialysis treatment. This action shows adequate comprehension and competency in managing this aspect of their care. Therefore, additional teaching is not necessary in this area. On the other hand, options A, C, and D present actions that may require further clarification or reinforcement in the teaching provided to the patient with acute glomerulonephritis.
Question 2 of 5
A home health nurse is working with a client who has chronic obstructive pulmonary disease. Which nursing diagnosis will take the highest priority for implementing client education?
Correct Answer: A
Rationale: Impaired Gas Exchange is the nursing diagnosis that should take the highest priority for implementing client education in a client with chronic obstructive pulmonary disease (COPD). Since COPD directly affects the ability of the lungs to take in oxygen and eliminate carbon dioxide, impaired gas exchange is a critical concern for these patients. By educating the client on proper breathing techniques, medication adherence, smoking cessation, and environmental triggers, the nurse can help in improving gas exchange and overall respiratory function. Addressing Impaired Gas Exchange as a priority can significantly impact the client's quality of life and prevent respiratory complications.
Question 3 of 5
The nurse is preparing to conduct a cardiac assessment for a pediatric client. Which location will the nurse use when auscultating the apical pulse?
Correct Answer: A
Rationale: When auscultating the apical pulse in pediatric clients, the nurse should place the stethoscope at the fifth intercostal space at the midclavicular line. This location is where the apex of the heart is located in pediatric clients and provides the most accurate assessment of the apical pulse. Placing the stethoscope at the left nipple (B) or right nipple (C) would not provide an accurate assessment of the apical pulse location. Auscultating at the eighth intercostal space (D) would be too low and not capture the apical pulse accurately.
Question 4 of 5
The mother of a baby born with a congenital heart defect is upset, as no one else in the family has been born with this condition. To determine the cause of the defect, which question is appropriate for the nurse to ask the mother?
Correct Answer: A
Rationale: The appropriate question for the nurse to ask the mother in this scenario is "Did you consume any alcohol before you knew you were pregnant?" This is because maternal alcohol consumption during pregnancy is a known risk factor for congenital heart defects. By asking this question, the nurse can gather crucial information to determine a potential cause for the baby's condition. It is important to address this potential risk factor to provide appropriate care and support to the mother and baby.
Question 5 of 5
The client's vital signs include P 119, R 24, BP 98/63, T 1°F, and SpO2 89%. Which actions would the nurse implement at this time? Select all that apply.
Correct Answer: B
Rationale: B. Coach in nonpharmacologic pain management techniques: The client's vital signs indicate they may be experiencing pain as evidenced by an elevated heart rate (P 119), which can be addressed initially with nonpharmacologic pain management techniques. This approach can help reduce pain and anxiety without the immediate need for medication.