ATI RN
Fundamental Concepts and Skills for Nursing 6th Edition Test Bank Questions
Question 1 of 5
The nurse is providing teaching about long-term anticoagulant therapy to a client recovering from a pulmonary embolism. Which client statement indicates that instruction has been effective?
Correct Answer: B
Rationale: The correct answer is B. The statement "I need to use a soft toothbrush and an electric razor to avoid injuries" indicates that the client understands the importance of preventive measures to minimize bleeding risks while on anticoagulant therapy. Using a soft toothbrush and an electric razor can help prevent accidental cuts that may lead to bleeding complications. It shows the client's understanding of the need to take precautions to avoid potential harm while on long-term anticoagulant therapy. The other statements do not directly address safety measures to prevent bleeding complications associated with anticoagulant therapy.
Question 2 of 5
The nurse notes that the patient has a low calcium level and plans to assess for Chvostek’s sign. How will the nurse conduct this assessment?
Correct Answer: C
Rationale: Chvostek’s sign is an assessment technique used to detect hypocalcemia. The nurse will tap lightly over the facial nerve, just in front of the patient’s ear. A positive Chvostek’s sign is indicated by a twitching of the facial muscles on the same side of the face as the area that was tapped. This twitching is due to the hyperexcitability of the facial nerve, which can be a sign of low calcium levels. Therefore, option C is the correct way to conduct the assessment for Chvostek’s sign.
Question 3 of 5
The nurse is preparing a patient for an intravenous pyelogram. What should be a part of the patient’s care at this time? Select all that apply.
Correct Answer: A
Rationale: A. Assess for allergies to seafood or iodine: It is essential to assess the patient for allergies to seafood or iodine because contrast material containing iodine is commonly used during an intravenous pyelogram (IVP). Allergic reactions to iodine can range from mild to severe, so assessing for allergies is crucial for patient safety.
Question 4 of 5
The nurse is planning care to reduce the risk of a patient in the intensive care unit from developing acute kidney injury. Which intervention should the nurse implement for this patient?
Correct Answer: C
Rationale: Acute kidney injury (AKI) is a common complication in critically ill patients in the intensive care unit (ICU). One of the primary interventions to reduce the risk of AKI is to maintain adequate fluid volume and cardiac output. Adequate hydration and adequate perfusion pressure are essential for renal function. Maintaining fluid volume and adequate cardiac output ensure that the kidneys receive enough blood flow and oxygen to function optimally. Conversely, inadequate fluid volume or low cardiac output can lead to decreased renal perfusion, predisposing the patient to AKI. Monitoring and optimizing fluid status and cardiac output are crucial in preventing AKI in high-risk patients in the ICU.
Question 5 of 5
The nurse is caring for a patient with a deep venous thrombosis of the left lower extremity. What additional body system should the nurse carefully monitor in this patient?
Correct Answer: C
Rationale: Patients with deep venous thrombosis (DVT) are at risk for developing a complication known as pulmonary embolism, which is a potentially life-threatening condition. A pulmonary embolism occurs when a blood clot dislodges from the veins, typically in the legs, and travels to the lungs, blocking blood flow. This can lead to respiratory symptoms such as shortness of breath, chest pain, and in severe cases, respiratory failure. Therefore, it is essential for the nurse to carefully monitor the respiratory system in a patient with DVT to promptly identify any signs of pulmonary embolism and initiate appropriate interventions to prevent further complications.