ATI RN
Nursing a Concept Based Approach Test Bank Questions
Question 1 of 5
The nurse is planning care for an older adult client with chronic venous insufficiency. Which will the nurse include in the client's teaching plan?
Correct Answer: B
Rationale: Elastic compression therapy, such as wearing elastic hose (compression stockings), is an essential component of managing chronic venous insufficiency. Compression stockings help improve venous return, reduce edema, and alleviate symptoms such as pain and swelling. They work by applying external pressure to the legs, promoting better circulation and preventing blood from pooling in the veins. The nurse should ensure that the client wears the compression stockings as prescribed to maximize their effectiveness in managing the condition.
Question 2 of 5
The nurse is preparing an educational session for employees of a manufacturing plant regarding emergency care of amputated digits. What should the nurse include when teaching about the type of injury?
Correct Answer: C
Rationale: When teaching about the type of injury of an amputated digit, the nurse should include the proper handling of the amputated part. The correct method is to wrap the amputated digit in a clean towel, place it in a sealed plastic bag to prevent direct contact with ice, and then place the bag on ice. Placing the amputated digit directly on ice can cause frostbite and further damage to the tissue. By following this method, the amputated digit can be preserved properly until medical help is received. Transporting the person to the hospital is important but proper handling of the amputated digit is critical to increase the chances of successful reattachment. Placing the amputated digit in warm water or taping it to the hand are not recommended methods for preserving an amputated digit.
Question 3 of 5
Following a kidney transplant, the nurse notes that a patient’s urine is cloudy. What should the nurse do about this finding?
Correct Answer: A
Rationale: Cloudy urine following a kidney transplant may be a common occurrence and could be due to various factors such as dehydration, medication side effects, or the presence of mucus, cells, or proteins in the urine. The nurse should first record the finding and then further assess the patient by checking for other signs and symptoms like pain, fever, or abnormal odors in the urine. If the cloudy urine is persistent or accompanied by other concerning symptoms, then the nurse should notify the physician for further evaluation. However, initially recording the finding allows for documentation and monitoring of the patient's condition, providing a baseline for further assessment and intervention if necessary. It is important to remember that cloudy urine alone may not always indicate a serious issue, but thorough assessment and documentation are essential steps in ensuring the patient's well-being.
Question 4 of 5
A client diagnosed with disseminated intravascular coagulation (DIC) is currently bleeding through the gastrointestinal tract. Which does the nurse anticipate administering to this client as a first line treatment?
Correct Answer: C
Rationale: Disseminated intravascular coagulation (DIC) is a serious condition characterized by widespread clot formation in the small blood vessels, leading to bleeding tendencies. In DIC, the body consumes clotting factors and platelets faster than they can be replaced, resulting in both bleeding and clotting. Because of this complex pathophysiology, the first line treatment for DIC-related bleeding is to provide replacement of the consumed clotting factors and platelets. Fresh frozen plasma contains clotting factors, and platelets help in stopping bleeding by aiding in clot formation. Therefore, the administration of fresh frozen plasma and platelets helps to correct the coagulopathy in DIC and manage the bleeding episodes effectively. Aspirin, Warfarin (Coumadin), and Heparin are anticoagulants and would not be appropriate in the treatment of DIC-related bleeding as they can exacerbate the bleeding tendency in this condition.
Question 5 of 5
The nurse teaches a client about lifestyle modifications to help manage hypertension. Which client statement indicates teaching has been effective?
Correct Answer: B
Rationale: This client statement indicates that they understand the importance of making lifestyle modifications to manage hypertension. Giving up cigarettes and alcohol can significantly improve blood pressure control and overall health for someone with hypertension. It demonstrates that the client is willing to make necessary changes to help manage their condition effectively.
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