ATI RN
Multidimensional Basis of Health Protective Behaviors Questions
Question 1 of 5
What sensation is used as a gauge so that patients with ileostomy can determine how often their pouch should be drained?
Correct Answer: B
Rationale: The correct answer is B: Sensation of pressure. Patients with ileostomy rely on the sensation of pressure to determine when to drain their pouch. As the pouch fills up with stool, they feel a sense of fullness or pressure, indicating the need for emptying. This sensation serves as a practical guide for maintaining pouch hygiene. Other choices like A (taste), C (smell), and D (urge to defecate) are not relevant in this context as they do not directly relate to the physical indication of when the pouch needs to be drained. Taste and smell are sensory perceptions, while the urge to defecate is a natural bodily function that is altered in patients with ileostomy.
Question 2 of 5
Mark, a 7-year-old client is brought to the emergency department. He's tachypneic and afebrile and has a respiratory rate of 36 breaths/minute and has a nonproductive cough. He recently had a cold. Form this history; the client may have which of the following conditions?
Correct Answer: A
Rationale: The correct answer is A: Acute asthma. The client's presentation of tachypnea, nonproductive cough, and recent cold is suggestive of an acute asthma exacerbation. Asthma commonly presents with these symptoms, especially in children. The absence of fever and productive cough makes bronchial pneumonia less likely. COPD and emphysema are typically seen in older individuals with a history of smoking, not in a 7-year-old child. Therefore, based on the client's age, symptoms, and absence of other risk factors, acute asthma is the most likely diagnosis.
Question 3 of 5
Nurse Kris is teaching a client with history of atherosclerosis. To decrease the risk of atherosclerosis, the nurse should encourage the client to:
Correct Answer: B
Rationale: The correct answer is B: Increase his activity level. Regular physical activity helps improve circulation, lower blood pressure, and reduce cholesterol levels, all of which can help decrease the risk of atherosclerosis. Exercise also helps maintain a healthy weight and reduces stress, which are additional risk factors for atherosclerosis. Explanation for other choices: A: Avoid focusing on his weight - Weight management is important in reducing the risk of atherosclerosis, so focusing on weight is beneficial. C: Follow a regular diet - Following a healthy diet is important, but alone may not be sufficient to reduce the risk of atherosclerosis without physical activity. D: Continue leading a high-stress lifestyle - High stress levels can contribute to the development of atherosclerosis, so it is important to reduce stress through relaxation techniques and exercise.
Question 4 of 5
After insertion of a cheat tube for a pneumothorax, a client becomes hypotensive with neck vein distention, tracheal shift, absent breath sounds, and diaphoresis. Nurse Amanda suspects a tension pneumothorax has occurred. What cause of tension pneumothorax should the nurse check for?
Correct Answer: B
Rationale: The correct answer is B: Kinked or obstructed chest tube. When a client with a pneumothorax develops hypotension, neck vein distention, tracheal shift, absent breath sounds, and diaphoresis, it indicates a tension pneumothorax. In this case, the chest tube may be kinked or obstructed, leading to a buildup of pressure in the pleural space. This increased pressure causes a shift in the mediastinum and impairs venous return, resulting in hypotension and other signs of tension pneumothorax. Checking for a kinked or obstructed chest tube is crucial to relieve the pressure and prevent further complications. Other choices are incorrect: A: Infection of the lung does not typically lead to the rapid onset of symptoms seen in tension pneumothorax. C: Excessive water in the water-seal chamber would not cause the described signs of tension pneumothorax. D: Ex
Question 5 of 5
The treatment for patients with leukemia is bone marrow transplantation. Which statement about bone marrow transplantation is not correct?
Correct Answer: A
Rationale: Correct Answer: A Rationale: A: The patient is under general anesthesia during bone marrow transplantation to ensure no discomfort or movement during the procedure, which involves inserting a needle into the bone. B: Aspirated bone marrow is mixed with anticoagulants like heparin to prevent clotting and ensure the cells remain viable. C: The iliac crest is a common site for bone marrow aspiration due to its accessibility and abundance of marrow-producing cells. D: The recipient receives preparatory chemotherapy like cyclophosphamide to suppress the immune system and reduce the risk of rejection during transplantation.