ATI RN
Giddens Concepts for Nursing Practice Test Bank Questions
Question 1 of 5
Which nursing intervention related to perfusion can be performed independently?
Correct Answer: C
Rationale: Teaching relaxation techniques related to perfusion can be independently performed by a nurse without requiring supervision or intervention from a healthcare provider. This nursing intervention focuses on promoting stress reduction and improving overall perfusion by enhancing circulation and decreasing the workload of the heart. The nurse can educate the patient on various relaxation techniques such as deep breathing exercises, guided imagery, progressive muscle relaxation, and meditation to help optimize perfusion levels. Additionally, teaching relaxation techniques empowers the patient to actively participate in their care and improve their overall well-being.
Question 2 of 5
A community health nurse is providing education to a group of adults regarding myocardial infarction (MI). When discussing ways to prevent the number of MI-related deaths, which statement by the nurse is inappropriate?
Correct Answer: B
Rationale: While taking a baby aspirin daily can be beneficial for some individuals at increased risk of heart attacks or strokes, it is not a general recommendation for everyone to prevent myocardial infarction (MI). There are potential risks associated with aspirin use, such as gastrointestinal bleeding, which could outweigh the benefits for individuals at low risk of a heart attack. It is important for individuals to consult with their healthcare provider before starting any regimen of daily aspirin therapy. The other statements (A, C, D) focus on increasing awareness, knowledge, and prompt action in response to a suspected MI, which are appropriate measures for prevention and improving outcomes.
Question 3 of 5
The nurse has identified Ineffective Peripheral Tissue Perfusion as a nursing diagnosis for a client with disseminated intravascular coagulation (DIC). What intervention would be appropriate for the client?
Correct Answer: B
Rationale: In the context of Ineffective Peripheral Tissue Perfusion in a client with disseminated intravascular coagulation (DIC), administering oxygen is the most appropriate intervention. DIC is a serious condition characterized by widespread clotting in small blood vessels throughout the body, leading to tissue ischemia and inadequate perfusion. Administering oxygen can support tissue oxygenation and improve perfusion to the peripheral tissues, helping to alleviate the effects of decreased blood flow and oxygen delivery caused by DIC. Oxygen therapy can help optimize oxygen levels in the blood and tissues, promoting better tissue perfusion and overall patient outcomes. Monitoring oxygen saturation and ensuring adequate oxygen delivery are crucial aspects of managing tissue perfusion in clients with DIC.
Question 4 of 5
The nurse is counseling a female client who wants to become pregnant. The client was diagnosed with heart failure 3 years ago and is currently in stage II heart failure. What information should the nurse include in her client teaching related to pregnancy and heart failure?
Correct Answer: B
Rationale: Pregnancy can put additional strain on the heart, especially in women with pre-existing heart conditions such as heart failure. Therefore, women with stage II heart failure should receive additional monitoring during pregnancy to ensure their heart function remains stable. This may include more frequent check-ups with a healthcare provider, additional tests such as echocardiograms, and potential adjustments to medications as needed to support the health of both the mother and the baby. It is important to closely monitor and manage the heart failure throughout pregnancy to reduce the risk of complications for both the mother and the unborn child.
Question 5 of 5
A client with preeclampsia begins to demonstrate manifestations of seizure activity. Which intervention by the nurse is most likely to protect the client and fetus from injury?
Correct Answer: B
Rationale: Placing the client on the left side and protecting the airway is the most appropriate intervention to protect the client and the fetus from injury during a seizure. This position helps to prevent aspiration of vomitus and maintains an open airway. Placing the client on the left side also enhances maternal and fetal perfusion by reducing pressure on the vena cava, improving blood flow to the placenta, and decreasing the risk of supine hypotensive syndrome. Elevating the client's legs (Option A) and placing the client in the supine position (Option C) are contraindicated as they may worsen the client's condition in the context of preeclampsia and seizure activity. Elevating the head of the bed (Option D) does not address the immediate need to protect the airway and maintain proper positioning during a seizure.