ATI RN
Multidimensional Basis of Health Protective Behaviors Questions
Question 1 of 5
The nurse is ware that the most relevant knowledge about oxygen administration to a male client with COPD is
Correct Answer: A
Rationale: The correct answer is A because in COPD patients, administering low flow oxygen at 1-2L/min helps maintain the hypoxic drive for breathing without causing oxygen toxicity. This is crucial as these patients rely on hypoxia to stimulate their respiratory drive due to chronically elevated CO2 levels. Choice B is incorrect because hypercapnia, not hypoxia, stimulates the central chemoreceptors. Choice C is incorrect as a nasal cannula is more appropriate for oxygen administration in COPD patients due to the risk of CO2 retention with a non-rebreathing mask. Choice D is incorrect as pulse oximetry is used to monitor oxygen saturation, not blood gases.
Question 2 of 5
A male client has jugular distention. On what position should the nurse place the head of the bed to obtain the most accurate reading of jugular vein distention?
Correct Answer: C
Rationale: The correct answer is C: Raised 30 degrees. Placing the client's head at a 30-degree angle allows gravity to pull the blood down from the head, providing a more accurate reading of jugular vein distention. In a supine position (choice D), the distention may be underestimated. High Fowler's position (choice A) may increase venous return and elevate the jugular vein further. Raising the bed by 10 degrees (choice B) may not provide enough angle for optimal blood flow.
Question 3 of 5
A female client is scheduled to receive a heart valve replacement with a porcine valve. Which of the following types of transplant is this?
Correct Answer: D
Rationale: The correct answer is D: Xenogeneic. A porcine valve is derived from pigs, making it a xenogeneic transplant. Allogeneic (A) refers to transplant between genetically different individuals of the same species. Autologous (B) involves using the patient's own tissue. Syngeneic (C) is transplant between genetically identical individuals, such as identical twins. In this case, since the heart valve is from a different species (pig), the correct term is xenogeneic.
Question 4 of 5
Cyrill with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client's urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse's suspicion of diabetes insipidus?
Correct Answer: D
Rationale: The correct answer is D. Diabetes insipidus results from inadequate production or action of antidiuretic hormone, leading to excessive urine output and dilute urine. In this case, the sudden rise in urine output above 200 ml/hour indicates a large volume of dilute urine being excreted. Therefore, the urine osmolality will be low (below normal) due to its diluteness. On the other hand, the serum osmolality will be high (above normal) because the body is unable to retain water properly, leading to dehydration and concentration of solutes in the blood. This imbalance in osmolality levels between urine and serum supports the nurse's suspicion of diabetes insipidus. Incorrect choices: A: Above-normal urine and serum osmolality levels - This is incorrect because in diabetes insipidus, urine osmolality is low (dilute) and serum osmolality is high. B: Below-normal urine and serum os
Question 5 of 5
Nurse Sarah expects to note an elevated serum glucose level in a client with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse anticipate?
Correct Answer: D
Rationale: The correct answer is D: Below-normal serum potassium level. In HHNS, there is severe hyperglycemia leading to osmotic diuresis and dehydration. As a result, potassium is lost in the urine, causing hypokalemia. This can lead to life-threatening cardiac arrhythmias. Elevated serum acetone level (A) and serum ketone bodies (B) are typically seen in diabetic ketoacidosis, not in HHNS. Serum alkalosis (C) is not commonly associated with HHNS.