ATI RN
foundation of nursing questions and answers Questions
Question 1 of 9
Which factor is known to increase the risk of gestational diabetes mellitus?
Correct Answer: A
Rationale: The correct answer is A: Previous birth of large infant. This factor increases the risk of gestational diabetes mellitus due to a history of delivering a large baby, indicating a higher likelihood of insulin resistance in subsequent pregnancies. Maternal age younger than 25 years (B) is not a known risk factor for gestational diabetes. Being underweight prior to pregnancy (C) is actually associated with a decreased risk of gestational diabetes. A previous diagnosis of type 2 diabetes mellitus (D) is a separate condition and does not directly increase the risk of gestational diabetes.
Question 2 of 9
The labor nurse is admitting a patient in active labor with a history of genital herpes. On assessment, the patient reports a recent outbreak, and the nurse verifies lesions on the perineum. What is the nurse’s next action?
Correct Answer: D
Rationale: The correct answer is D: Use electronic fetal surveillance to determine a baseline fetal heart rate. This is important in assessing the well-being of the fetus during labor, especially in the presence of genital herpes lesions. Monitoring the fetal heart rate helps in detecting any signs of distress or compromise due to maternal infection. A: Asking about the patient's last intake is important but not the immediate priority when managing a patient with active genital herpes lesions in labor. B: Taking a culture of the lesions might be helpful but not the immediate action needed in this situation. C: Asking about unprotected sex is relevant but not as critical as monitoring the fetal well-being during labor in this scenario. Overall, the most critical action is to monitor the fetal heart rate for any signs of distress related to the maternal herpes infection.
Question 3 of 9
A nurse is preparing a bowel training programfor a patient. Which actions will the nurse take? (Select all that apply.)
Correct Answer: A
Rationale: The correct answer is A. Recording times when the patient is incontinent is crucial in identifying patterns and establishing a structured bowel training program. This data helps in determining the optimal timing for toileting. Choices B, C, and D are incorrect. Choice B is not specific to bowel training and may not address the patient's individual needs. Choice C is not a recommended posture for effective bowel elimination. Choice D, while important for overall health, is not directly related to bowel training.
Question 4 of 9
A patient has had a total mastectomy with immediate reconstruction. The patient asks the nurse when she can take a shower. What should the nurse respond?
Correct Answer: A
Rationale: The correct answer is A: Not until the drain is removed. After a mastectomy with immediate reconstruction, there is typically a drain in place to collect fluid. Showering before the drain is removed can increase the risk of infection and disrupt the healing process. It is important to wait until the healthcare provider removes the drain to ensure proper healing and reduce the risk of complications. Summary: B: On the second postoperative day - Too early, the drain needs to be removed first. C: Now, if you wash gently with soap and water - Incorrect, the drain should be removed before showering. D: Seven days after your surgery - Incorrect, waiting for a specific number of days is not necessary, it depends on when the drain is removed.
Question 5 of 9
A 76-year-old with a diagnosis of penile cancer has been admitted to the medical floor. Because the incidence of penile cancer is so low, the staff educator has been asked to teach about penile cancer. What risk factors should the educator cite in this presentation? Select all that apply.
Correct Answer: A
Rationale: The correct answer is A: Phimosis. Phimosis, the inability to retract the foreskin over the glans penis, is a significant risk factor for penile cancer. Phimosis can lead to poor hygiene, inflammation, and chronic irritation, increasing the risk of cancer development. The other choices (B: Priapism, C: Herpes simplex infection, D: Increasing age, E: Lack of circumcision) are not directly linked to penile cancer development. Priapism is prolonged and painful erection unrelated to penile cancer. Herpes simplex infection is a viral infection and not a primary risk factor for penile cancer. Increasing age is a general risk factor for many cancers, but it is not specific to penile cancer. Lack of circumcision has been associated with a slightly higher risk of penile cancer, but it is not as significant as phimosis.
Question 6 of 9
The nurse is caring for a patient who is to begin receiving external radiation for a malignant tumor of the neck. While providing patient education, what potential adverse effects should the nurse discuss with the patient?
Correct Answer: A
Rationale: The correct answer is A: Impaired nutritional status. Radiation therapy to the neck can lead to mucositis, dysphagia, and taste changes, which can impair the patient's ability to eat and maintain adequate nutrition. This can lead to weight loss, weakness, and delayed wound healing. Discussing this potential adverse effect with the patient is crucial for proactive management. Choice B: Cognitive changes, and Choice C: Diarrhea are less likely to be direct adverse effects of radiation therapy to the neck. Cognitive changes are more commonly associated with brain radiation, while diarrhea is a more common side effect of abdominal radiation. Choice D: Alopecia is a side effect of chemotherapy, not radiation therapy. Radiation therapy does not typically cause hair loss unless it is in the treatment field. Therefore, discussing alopecia with the patient receiving radiation for a malignant neck tumor is not a priority.
Question 7 of 9
A nurse has provided care to a patient. Whichentry should the nurse document in the patient’s record?
Correct Answer: C
Rationale: The correct answer is C because it provides specific, objective information about the patient's left knee incision, including its size and absence of concerning signs. This entry is relevant, concise, and focuses on a specific aspect of the patient's condition, aiding in continuity of care and treatment planning. Choice A is vague and lacks detail, making it insufficient for accurate patient care documentation. Choice B focuses on the patient's subjective feelings and does not provide objective assessment data. Choice D is judgmental and includes unnecessary information about the patient's behavior and family presence, which is not directly related to the patient's condition.
Question 8 of 9
A nurse is creating a plan of care for an oncology patient and one of the identified nursing diagnoses is risk for infection related to myelosuppression. What intervention addresses the leading cause of infection- related death in oncology patients?
Correct Answer: D
Rationale: The correct answer is D: Assess the integrity of the patients oral mucosa regularly. Myelosuppression leads to decreased white blood cells, increasing infection risk. The oral mucosa can be a common site for infections. Regular assessment helps in early detection and intervention. A: Encouraging small meals does not directly address infection risk in myelosuppressed patients. B: Providing skin care is important for overall patient care but does not directly address the leading cause of infection-related death. C: Assisting with hygiene is important but does not specifically target the leading cause of infection-related death in oncology patients.
Question 9 of 9
A patient with otosclerosis has significant hearing loss. What should the nurse do to best facilitate communication with the patient?
Correct Answer: A
Rationale: The correct answer is A: Sit or stand in front of the patient when speaking. This choice is correct because it allows the patient with otosclerosis to directly see the nurse's face and lip movements, aiding in lip-reading and understanding speech. Sitting or standing in front of the patient also ensures better eye contact and reduces background noise interference. Choice B is incorrect because exaggerated lip and mouth movements may distort speech and make it harder for the patient to understand. Choice C is incorrect because standing in front of a light or window can create glare and make it difficult for the patient to see the nurse's face clearly. Choice D is incorrect because saying the patient's name loudly before starting to talk does not directly address the communication needs of a patient with otosclerosis.