ATI RN
foundations of nursing practice questions Questions
Question 1 of 9
The nurse leading an educational session is describing self-examination of the breast. The nurse tells the womens group to raise their arms and inspect their breasts in a mirror. A member of the womens group asks the nurse why raising her arms is necessary. What is the nurses best response?
Correct Answer: A
Rationale: The correct answer is A: It helps to spread out the fat that makes up your breast. Raising the arms during breast self-examination stretches the breast tissue, making it easier to detect any lumps or abnormalities. This action also helps to distribute the breast tissue evenly, providing a clearer view of the entire breast. This method ensures a more thorough examination and increases the chances of detecting any changes in the breast tissue early on. Summary of incorrect choices: B: It allows you to simultaneously assess for pain - Although assessing for pain is important, raising the arms specifically helps with spreading out the breast tissue, not necessarily for assessing pain. C: It will help to observe for dimpling more closely - While observing for dimpling is important, raising the arms is primarily for spreading out the breast tissue, not for observing dimpling. D: This is what the American Cancer Society recommends - While recommendations from reputable sources are important, the rationale behind raising the arms during breast self-examination is not solely
Question 2 of 9
While reviewing the health history of an older adult experiencing hearing loss the nurse notes the patient has had no trauma or loss of balance. What aspect of this patients health history is most likely to be linked to the patients hearing deficit?
Correct Answer: D
Rationale: The correct answer is D: Previous perforation of the eardrum. A perforated eardrum can lead to hearing loss as it affects the transmission of sound waves to the inner ear. This is the most likely link to the patient's hearing deficit as trauma or injury to the eardrum can directly impact hearing. Incorrect choices: A: Recent completion of radiation therapy for treatment of thyroid cancer - Radiation therapy for thyroid cancer typically does not directly affect hearing. B: Routine use of quinine for management of leg cramps - Quinine use is associated with tinnitus (ringing in the ears) but not typically with hearing loss. C: Allergy to hair coloring and hair spray - Allergy to hair products is not directly related to hearing loss. In summary, the most likely cause of the patient's hearing deficit based on the health history provided is the previous perforation of the eardrum, as it directly affects the transmission of sound waves to the inner ear.
Question 3 of 9
The nurse is discussing the results of a patients diagnostic testing with the nurse practitioner. What Weber test result would indicate the presence of a sensorineural loss?
Correct Answer: C
Rationale: The correct answer is C because in sensorineural hearing loss, the sound is heard better in the ear with poorer hearing due to damage to the inner ear or auditory nerve. This is because the brain perceives the sound as louder in the affected ear to compensate for the hearing loss. Choice A is incorrect as it describes the result for conductive hearing loss. Choice B is incorrect as it indicates normal hearing. Choice D is incorrect as it describes the result for a lateralizing conductive hearing loss.
Question 4 of 9
A patient with a family history of allergies has suffered an allergic response based on a genetic predisposition. This atopic response is usually mediated by what immunoglobulin?
Correct Answer: D
Rationale: The correct answer is D: Immunoglobulin E. The atopic response in allergies is mainly mediated by IgE antibodies. IgE binds to allergens and triggers the release of histamine and other chemicals that cause allergic symptoms. IgA is mainly found in mucosal areas, IgM is involved in early immune responses, and IgG is important for long-term immunity. IgE is specifically associated with allergic reactions due to its role in sensitizing mast cells and basophils to allergens.
Question 5 of 9
A patient is 24 hours postoperative following prostatectomy and the urologist has ordered continuous bladder irrigation. What color of output should the nurse expect to find in the drainage bag?
Correct Answer: A
Rationale: The correct answer is A: Red wine colored. Following a prostatectomy, continuous bladder irrigation is commonly used to prevent blood clots and ensure urine drainage. The output is expected to be red wine colored, indicating the presence of blood in the urine due to surgical trauma. Tea-colored (choice B) or amber (choice C) are not specific enough and do not accurately reflect the expected bloody output. Light pink (choice D) may suggest a lower level of bleeding compared to red wine color, but it is not the most accurate description for post-prostatectomy drainage.
Question 6 of 9
A nurse needs to know how to find, evaluate, and use information effectively.
Correct Answer: C
Rationale: The correct answer is C: Clinical decision support system. A clinical decision support system is a type of system or design that helps healthcare professionals, including nurses, in making clinical decisions by providing them with relevant information and knowledge. This system assists in analyzing data to generate patient-specific recommendations or alerts to improve patient care. In the given scenario, the nurse's need to find, evaluate, and use information effectively aligns with the purpose of a clinical decision support system. This system enables the nurse to access evidence-based information, guidelines, and recommendations to enhance their decision-making process and improve patient outcomes. Summary of why other choices are incorrect: A: Computer competency does not equate to informatics competency. While computer skills are important, informatics involves a deeper understanding of using information effectively in practice. B: This choice provides a detailed explanation of informatics but does not directly address the type of system or design the nurse would be using to find, evaluate, and use information effectively. D: Nursing process
Question 7 of 9
A public health nurse is participating in a campaign aimed at preventing cervical cancer. What strategies should the nurse include is this campaign? Select all that apply.
Correct Answer: A
Rationale: The correct answer is A: Promotion of HPV immunization. This strategy is effective in preventing cervical cancer by targeting the main cause, which is Human Papillomavirus (HPV). The HPV vaccine can protect against the most common types of HPV that cause cervical cancer. Encouraging young women to delay first intercourse (B) does not directly prevent HPV transmission, as the virus can be transmitted through other means. Smoking cessation (C) is important for overall health but does not specifically prevent cervical cancer. Vitamin D and calcium supplementation (D) may have general health benefits but do not directly prevent cervical cancer. Using safer sex practices (E) can reduce the risk of HPV transmission but does not provide the same level of protection as HPV immunization.
Question 8 of 9
A patient has been admitted to the emergency department with signs of anaphylaxis following a bee sting. The nurse knows that if this is a true allergic reaction the patient will present with what alteration in laboratory values?
Correct Answer: A
Rationale: The correct answer is A: Increased eosinophils. Eosinophils are a type of white blood cell involved in allergic reactions. During anaphylaxis, the body releases chemicals that stimulate the production and activation of eosinophils, leading to an increase in their count. This helps in the identification of an allergic reaction. Incorrect Choices: B: Increased neutrophils - Neutrophils are not specific to allergic reactions and are typically increased in bacterial infections. C: Increased serum albumin - Serum albumin levels are not directly affected by allergic reactions. D: Decreased blood glucose - Hypoglycemia is not a typical manifestation of an allergic reaction.
Question 9 of 9
A nurse is providing care to a patient with anindwelling catheter. Which practice indicates the nurse is following guidelines for avoiding catheter-associated urinary tract infection (CAUTI)?
Correct Answer: A
Rationale: The correct answer is A: Drapes the urinary drainage tubing with no dependent loops. This practice helps prevent CAUTI by ensuring that urine does not flow back into the bladder, reducing the risk of infection. Dependent loops can lead to stagnant urine, providing a breeding ground for bacteria. Choice B is incorrect because washing the drainage tube towards the meatus can introduce bacteria into the urinary tract, increasing the risk of infection. Choice C is incorrect because placing the drainage bag on the floor can introduce contaminants from the floor into the system. Choice D is incorrect because allowing the spigot to touch the receptacle can lead to contamination and increase the risk of infection.