ATI RN
Introduction to Professional Nursing Questions
Question 1 of 5
To perform postural drainage on a patient, the nurse should:
Correct Answer: D
Rationale: The correct answer is D because performing postural drainage before the client takes his meal helps prevent aspiration during the procedure. Aspiration can occur if the patient has recently eaten, increasing the risk of food or liquid entering the lungs. Choices A, B, and C are incorrect because drinking water before the procedure, suctioning the patient, or asking about comfort positions are not directly related to preventing aspiration during postural drainage.
Question 2 of 5
A patient on I. V. heparin should have which of the following laboratory values monitored closely to determine whether the therapeutic range is maintained?
Correct Answer: C
Rationale: The correct answer is C: Partial Thromboplastin Time (PTT). PTT measures the effectiveness of heparin as it reflects the clotting time. Monitoring PTT ensures the therapeutic range of heparin is maintained to prevent clotting or bleeding. Hemoglobin (A) monitors anemia, INR (B) is used to monitor Warfarin therapy, and Prothrombin Time (D) is used for monitoring Warfarin therapy, not heparin.
Question 3 of 5
A nurse is caring for an older client who exhibits dehydration-induced confusion. Which intervention by the nurse is best?
Correct Answer: C
Rationale: The correct answer is C: Increase the IV flow rate to 250 mL/hr. Dehydration-induced confusion requires prompt correction of fluid deficit. Increasing IV flow rate will help rehydrate the client more quickly, addressing the underlying cause of confusion. This intervention is directly related to resolving dehydration. A: Measuring intake and output every 4 hours is important for monitoring fluid balance but will not address dehydration promptly. B: Assessing the client further for fall risk is important but does not directly address the underlying cause of confusion. D: Placing the client in a high-Fowler position can help with respiratory issues but does not directly address dehydration-induced confusion.
Question 4 of 5
A patient’s 4 X 3-cm leg wound has a 0.4-cm black area in the center of the wound surrounded by yellow-green semiliquid material. Which dressing should the nurse apply to the wound?
Correct Answer: C
Rationale: The correct answer is C: Hydrocolloid dressing. This type of dressing is ideal for a wound with yellow-green semiliquid material, as it helps to maintain a moist environment which promotes wound healing. The black area in the center could indicate necrotic tissue, and the hydrocolloid dressing can help to facilitate autolytic debridement. Dry gauze dressing (A) would not be suitable as it can adhere to the wound bed, causing trauma during removal. Nonadherent dressing (B) may not provide adequate moisture for healing. Transparent film dressing (D) may not be ideal as it does not provide the same level of absorption and protection as a hydrocolloid dressing.
Question 5 of 5
The nurse assesses a patient on the second postoperative day after abdominal surgery to repair a perforated duodenal ulcer. Which finding is most important for the nurse to report to the surgeon?
Correct Answer: B
Rationale: The correct answer is B: Fine crackles audible at both lung bases. This finding is most important to report because it suggests potential respiratory complications like atelectasis or pneumonia, which are common postoperative issues. The nurse should report this immediately to prevent further respiratory deterioration. A: Tympanic temperature of 99.2°F is slightly elevated but not a critical finding postoperatively. C: Redness and swelling along the suture line are common signs of surgical healing and expected in the early postoperative period. D: 200 mL sanguineous fluid in the wound drain is within the expected range for the second postoperative day after abdominal surgery and does not indicate an immediate concern.