ATI RN
Multi Dimensional Care | Final Exam Questions
Question 1 of 5
What is the most common method of reducing and immobilizing a fracture?
Correct Answer: D
Rationale: Open reduction with internal fixation (ORIF) is the most common method for reducing and immobilizing fractures because it provides direct visualization and alignment of bone fragments while offering stable fixation through implants like plates, screws, or rods. This approach ensures anatomical reduction, which is critical for proper healing, especially in displaced or complex fractures. The internal fixation hardware maintains alignment during the healing process, allowing for early mobilization and rehabilitation, reducing complications like malunion or nonunion. ORIF is preferred for intra-articular fractures (where joint surfaces are involved) and comminuted fractures (multiple bone fragments) because it restores function and stability more effectively than external methods. Choice A (Open reduction with external fixation) is incorrect because external fixation is typically reserved for severe open fractures, cases with significant soft tissue damage, or temporary stabilization. While open reduction allows direct visualization, external fixators are bulkier, limit mobility, and carry a higher risk of pin-site infections. They are not as stable as internal fixation for long-term fracture healing and are usually a bridge to definitive treatment rather than the primary method. Choice B (External reduction and internal fixation) is incorrect because "external reduction" is not a standard medical term. Reduction refers to realigning bone fragments, which can only be done through closed (non-surgical) or open (surgical) methods. Pairing "external reduction" with internal fixation is a contradiction—internal fixation requires surgical access, making the phrase nonsensical in clinical practice. Choice C (External fixation with closed reduction) is incorrect because while closed reduction (manipulation without surgery) is less invasive, it is often insufficient for unstable or complex fractures. External fixation alone lacks the precision of internal fixation and may not maintain adequate alignment, leading to poor healing outcomes. This method is more commonly used in emergency settings or for temporary stabilization before ORIF, not as the definitive treatment for most fractures. The superiority of ORIF lies in its ability to combine precise anatomical alignment with robust mechanical stability, facilitating optimal bone healing and functional recovery. Other methods either lack the necessary stability (external fixation) or are misrepresented concepts (external reduction), making them unsuitable as the most common or effective approach.
Question 2 of 5
The goal for a client with impaired mobility is to prevent atelectasis. What nursing intervention would best help the client meet this goal?
Correct Answer: A
Rationale: Atelectasis refers to the partial or complete collapse of lung tissue, often caused by inadequate lung expansion due to immobility, shallow breathing, or obstruction. Preventing atelectasis in clients with impaired mobility requires interventions that promote lung expansion and ventilation. **Option A (Assist the client to orthopneic position)** is correct because the orthopneic position—sitting upright and leaning slightly forward with arms supported on a table or overbed tray—maximizes lung expansion by reducing pressure on the diaphragm and allowing for deeper breaths. This position is especially beneficial for clients with respiratory compromise, as it improves alveolar ventilation and prevents the pooling of secretions that could lead to atelectasis. By facilitating deeper inhalation, it counteracts the shallow breathing patterns common in immobile clients. **Option B (Offer a protein-rich diet)** is incorrect because while nutrition is important for overall health and tissue repair, a protein-rich diet does not directly address the mechanical issue of lung collapse. Atelectasis is primarily a respiratory complication, not a nutritional one. Although proper nutrition supports immune function and healing, it does not improve lung expansion or secretion clearance, which are the primary mechanisms for preventing atelectasis. **Option C (Offer the client a bedpan for toileting)** is incorrect because using a bedpan does not promote lung expansion. In fact, prolonged bedpan use may contribute to immobility and discomfort, which can exacerbate shallow breathing. Encouraging mobility (e.g., assisting the client to a chair or commode) would be more beneficial for respiratory function, as movement helps stimulate deeper breathing and circulation. **Option D (Turn the client every 4 hours)** is incorrect because turning every 4 hours is insufficient to prevent atelectasis in most cases. While repositioning is important for preventing pressure injuries and improving circulation, it does not guarantee adequate lung expansion. More frequent turning (e.g., every 2 hours) combined with deep breathing exercises or incentive spirometry would be more effective. The orthopneic position is a more targeted intervention for directly addressing lung ventilation. The key to preventing atelectasis lies in interventions that actively promote lung expansion and secretion mobilization. The orthopneic position achieves this by optimizing the mechanics of breathing, whereas the other options either address unrelated needs or are insufficiently targeted to respiratory function.
Question 3 of 5
The following client come to the ophthalmology clinic. Which client needs to be seen first?
Correct Answer: A
Rationale: **Rationale:** **A: Client who had recent cataract surgery and worsening vision** This client is the highest priority due to the risk of **postoperative complications**, such as **endophthalmitis (infection inside the eye)**, **retinal detachment**, or **cystoid macular edema**, which can lead to **permanent vision loss** if not treated urgently. Cataract surgery involves an incision in the eye, making it susceptible to infection or inflammation. Worsening vision postoperatively is a **red flag** requiring **immediate evaluation** to prevent irreversible damage. **B: Client with an absent red reflex** An absent red reflex can indicate serious conditions like **retinoblastoma (in children)**, **cataracts**, or **vitreous hemorrhage**. While concerning, this finding is not **immediately life- or vision-threatening** unless accompanied by acute symptoms (e.g., pain, sudden vision loss). A thorough workup is needed, but it does not take precedence over an acute postoperative complication like worsening vision after surgery. **C: Client with an intraocular pressure (IOP) of 24 mm Hg** An IOP of **24 mm Hg is elevated** (normal range: 10–21 mm Hg) and may suggest **glaucoma**, but it is not an emergency unless accompanied by **acute angle-closure glaucoma symptoms** (severe eye pain, nausea, sudden vision loss, halos around lights). Chronic glaucoma management can wait for routine evaluation, whereas acute postoperative changes demand **urgent intervention**. **D: Client with a tearing, reddened eye with exudate** This presentation suggests **conjunctivitis (viral or bacterial)**, **allergic reaction**, or **blepharitis**. While uncomfortable, these are **not sight-threatening** and can typically be managed with topical treatments. **No immediate intervention** is needed unless signs of **corneal involvement** (e.g., photophobia, severe pain) are present. **Conclusion:** The **postoperative cataract patient with worsening vision (Option A)** is the **highest priority** due to the risk of **surgical complications** that can rapidly progress to **permanent visual impairment**. The other conditions (B, C, D) are either **non-emergent** or require further evaluation but do not pose the same **urgent threat** to vision.
Question 4 of 5
A client sustained a crushing injury to his right arm during a car accident. He arrives to the emergency room complaining of numbness in his right hand. He has no other injuries. What should the nurse do first?
Correct Answer: A
Rationale: The rationale for the correct answer and incorrect choices in this scenario is as follows: **Assess the right radial pulse (Correct Answer):** A crushing injury to the arm can lead to **compartment syndrome**, vascular damage, or nerve compression, all of which can compromise circulation and sensation. Numbness in the hand suggests possible **neurovascular impairment**, making immediate assessment of the radial pulse critical. The radial pulse is the most direct way to evaluate blood flow to the affected limb. If the pulse is weak, absent, or asymmetrical compared to the other arm, it indicates **ischemia** or **vascular injury**, requiring urgent intervention (e.g., surgical evaluation or compartment pressure measurement). Additionally, a diminished pulse alongside numbness supports the possibility of **nerve compression secondary to swelling or hematoma**. Thus, assessing circulation first ensures timely detection of life- or limb-threatening complications before proceeding with other interventions. **Call the provider (Incorrect Choice):** While notifying the provider is necessary, it should not be the *first* action without initial assessment data. The nurse must first **gather objective findings** (e.g., pulse strength, capillary refill, motor function) to provide the provider with a complete clinical picture. Calling without assessment risks delays in critical information, potentially leading to miscommunication or inadequate urgency in the provider’s response. For example, if the radial pulse is absent, the nurse can immediately escalate the situation as an emergency; if present, they may instead report stable findings with ongoing monitoring. **Administer pain medication (Incorrect Choice):** Pain management is important but **not the priority** in this case. Numbness, rather than pain, is the primary symptom, signaling potential **neurovascular compromise** rather than just tissue damage. Administering analgesics (especially opioids) could mask worsening symptoms (e.g., increasing pain unrelieved by medication, a red flag for compartment syndrome). Additionally, analgesics do not address the underlying cause of numbness, which could escalate to permanent damage if circulation is not restored promptly. Pain relief should follow *after* ensuring perfusion and nerve function are intact. **Assess the right pedal pulse (Incorrect Choice):** The pedal pulse is irrelevant in this context because the injury is localized to the **arm**. Assessing a lower extremity pulse would not provide information about vascular integrity in the affected limb. While systemic circulation checks (e.g., blood pressure) are part of trauma assessments, the focus here must be on the **right arm’s neurovascular status**. A pedal pulse assessment delays critical evaluation of the injury site and could result in missing signs of **compartment syndrome or arterial occlusion** specific to the arm. In summary, the correct sequence is to **first assess the radial pulse** to determine circulatory integrity, then proceed with provider notification or interventions based on findings. The incorrect choices either delay essential assessment, address non-urgent needs, or focus on unrelated systems, potentially compromising patient outcomes.
Question 5 of 5
What may be a cause of conductive hearing loss?
Correct Answer: D
Rationale: Conductive hearing loss occurs when sound waves cannot efficiently travel through the outer or middle ear to reach the inner ear. This can be due to physical blockages, structural abnormalities, or conditions affecting the ear's conductive pathway. **Otitis media (D)**, an infection or inflammation of the middle ear, is a classic cause of conductive hearing loss. Fluid buildup or pus in the middle ear space impedes the movement of the ossicles (tiny bones) and eardrum, disrupting sound conduction. This is particularly common in children due to their shorter, more horizontal Eustachian tubes, which are prone to blockages. The fluid's presence dampens vibrations, leading to temporary hearing impairment until the infection resolves or is treated. **Prolonged exposure to loud noises (A)** typically causes sensorineural hearing loss, not conductive. This type of damage affects the hair cells in the cochlea or the auditory nerve, impairing the conversion of sound vibrations into neural signals. While noise-induced hearing loss is a leading cause of auditory deficits, it doesn’t involve the mechanical obstruction characteristic of conductive loss. **Medications (B)**, particularly ototoxic drugs like certain antibiotics (e.g., gentamicin) or chemotherapy agents, also cause sensorineural hearing loss. These substances damage the inner ear’s delicate structures or the auditory nerve, disrupting neural signal transmission. Unlike conductive loss, this damage is often irreversible and doesn’t involve physical barriers in the outer or middle ear. **Presbycusis (C)** is age-related hearing loss and is exclusively sensorineural. It results from degenerative changes in the cochlea, auditory nerve, or brain’s auditory processing centers over time. While it shares symptoms like difficulty hearing high frequencies with some conductive losses, the underlying mechanism is entirely different—no physical blockage or middle ear dysfunction is involved. The key distinction lies in the affected anatomical region: conductive loss involves the outer/middle ear’s mechanical pathway, while sensorineural loss stems from inner ear or neural damage. Otitis media directly interferes with conduction, making it the only correct choice here. The other options, while significant causes of hearing impairment, belong to a separate category of auditory dysfunction. Understanding these differences is critical for accurate diagnosis and treatment, as conductive losses (e.g., from infections or earwax) are often treatable, whereas sensorineural losses may require hearing aids or cochlear implants.