What is one condition that can require an order for a tube feeding?

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Question 1 of 5

What is one condition that can require an order for a tube feeding?

Correct Answer: B

Rationale: The correct answer is B: Cancer. Cancer can lead to difficulty eating or swallowing, causing malnutrition. Tube feeding ensures adequate nutrition. Depression (A) does not directly require tube feeding. Dialysis (C) treats kidney failure, not a reason for tube feeding. Anaphylaxis (D) is a severe allergic reaction, not a condition necessitating tube feeding.

Question 2 of 5

The nurse and the nursing assistive personnel are assisting a postoperative patient to turn in bed. To assist in minimizing discomfort, which instruction should the nurse provide to the patient?

Correct Answer: D

Rationale: The correct answer is D because placing the hand over the incision provides support and stability, reducing discomfort during the turning process. This action helps prevent unnecessary strain on the incision site and promotes healing. A, B, and C are incorrect because closing eyes or thinking about something pleasant, holding breath, and grabbing shoulders do not provide physical support or address the specific discomfort related to postoperative turning in bed.

Question 3 of 5

Which of the following conditions is most likely to cause a patient to present with potentially reversible pulseless electrical activity on the monitor?

Correct Answer: D

Rationale: The correct answer is D: Tension pneumothorax. This condition can lead to decreased venous return to the heart, causing decreased cardiac output and ultimately pulseless electrical activity. Tension pneumothorax is a life-threatening emergency that requires immediate intervention to relieve pressure on the heart and lungs. A: Traumatic asphyxia can cause compression of the chest and airway obstruction, leading to respiratory distress but not necessarily pulseless electrical activity. B: Wolf Parkinson White syndrome is a cardiac condition characterized by an accessory pathway for electrical conduction in the heart, which can cause arrhythmias but not typically pulseless electrical activity. C: The R-on-T phenomenon refers to a specific ECG finding where a premature ventricular contraction occurs on the T wave of the preceding beat, which can lead to ventricular fibrillation but is less likely to result in pulseless electrical activity compared to tension pneumothorax.

Question 4 of 5

You suspect your unconscious adult trauma patient may have increased intracranial pressure from a closed head injury. Due to the compression forces of increased intracranial pressure, at what level of brain injury would be expected if the patient is exhibiting Cheyne-Stokes respirations and is presenting with increasing blood pressure readings and a decreasing, reactive pulse rate?

Correct Answer: A

Rationale: Step 1: Cheyne-Stokes respirations suggest dysfunction in the cerebral cortex and upper brainstem. Step 2: Increasing blood pressure and decreasing, reactive pulse rate indicate a raised intracranial pressure affecting the cortex and upper brainstem. Step 3: Compression in the cortex and upper brainstem can lead to autonomic dysregulation causing the observed symptoms. Step 4: Midbrain, medulla oblongata, and lower brainstem are not directly associated with the symptoms described. Summary: The correct answer is A because the symptoms presented are indicative of dysfunction in the cortex and upper brainstem, while the other choices do not align with the specific symptoms observed in the patient.

Question 5 of 5

You suspect your adult trauma patient has a potential complete spinal cord transection. If so, which of the following would you expect to find?

Correct Answer: C

Rationale: The correct answer is C. In a complete spinal cord transection, there is total absence of pain, sensation, and movement below the level of injury due to complete disruption of nerve pathways. This results in paralysis below the injury site. A is incorrect because a complete transection would result in total loss of pain, sensation, and movement, not just some loss of movement. B is incorrect as bradycardia and loss of vascular tone are indicative of autonomic dysreflexia, typically seen in spinal cord injuries above T6, not a complete transection. D is incorrect as right-sided paralysis with decreased sensation on the opposite side does not align with the expected presentation of a complete spinal cord transection.

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