Questions 9

ATI RN

ATI RN Test Bank

Nursing Process Practice Questions Quizlet Questions

Question 1 of 5

Which of the ff is a reason for providing early discharge instructions and making arrangements for home care for clients undergoing mastectomy?

Correct Answer: C

Rationale: Step 1: Most clients are not hospitalized long after a mastectomy - Correct. This is because mastectomy is often performed as an outpatient procedure, and clients are discharged home shortly after surgery. Step 2: The adverse effects of mastectomy are not immediate - Incorrect. Adverse effects may occur post-surgery, but early discharge is not solely due to immediate adverse effects. Step 3: The wound of the surgery is not highly contagious - Incorrect. Mastectomy wounds are not contagious, and isolation precautions are not necessary. Step 4: Suicidal tendencies in women undergoing mastectomy are not high - Incorrect. While emotional support is crucial, early discharge is not primarily due to suicidal tendencies. Summary: Choice C is correct because mastectomy clients are typically not hospitalized long, making early discharge instructions and home care arrangements necessary. Choices A, B, and D are incorrect as they do not directly relate to the primary reason for early discharge and home care planning.

Question 2 of 5

Why would a Heimlich maneuver be performed on a client?

Correct Answer: B

Rationale: The Heimlich maneuver is performed to clear the airway if a client is choking and cannot speak or breathe after swallowing food. Step 1: Assess the situation and confirm airway obstruction. Step 2: Stand behind the client, wrap your arms around their waist, and deliver upward abdominal thrusts. Step 3: Repeat thrusts until the object is dislodged. Other choices are incorrect as they do not address airway obstruction. A: Increasing medication absorption is not a purpose of the Heimlich maneuver. C: Preventing falls and D: Maintaining extremities in proper position are not related to choking emergencies.

Question 3 of 5

Which of the following is the most important assessment during the acute stage of an unconscious patient like Mr. Franco?

Correct Answer: D

Rationale: The correct answer is D: Patency of airway and adequacy of respiration. During the acute stage of an unconscious patient like Mr. Franco, ensuring the airway is open and that breathing is adequate is the top priority to maintain oxygenation and prevent complications like hypoxia. This assessment is crucial for immediate intervention and can be life-saving. A: Level of awareness and response to pain may provide important information but is secondary to ensuring a patent airway and adequate breathing in an unconscious patient. B: Pupillary reflexes and response to sensory stimuli are important neurological assessments, but airway and breathing take precedence in the acute stage to maintain vital functions. C: Coherence and sense of hearing are not as critical as assessing and maintaining the airway and breathing in an unconscious patient.

Question 4 of 5

During outcome identification and planning, from what part of the nursing diagnoses are outcomes derived?

Correct Answer: C

Rationale: During outcome identification and planning, outcomes are derived from the problem statement of the nursing diagnoses. This is because the problem statement clearly defines the patient's health issue or condition that needs to be addressed, thus guiding the development of specific, measurable, and achievable outcomes. The defining characteristics (choice A) describe the signs and symptoms of the health problem but do not directly lead to outcome identification. The related factors (choice B) represent the potential causes or contributing factors to the health problem and are not used to derive outcomes. The database (choice D) consists of the patient's health history, assessment data, and laboratory findings, which are essential for diagnosing but do not directly determine outcomes. Therefore, the correct answer is C as it directly informs the outcomes to be achieved.

Question 5 of 5

A patient’s son decides to stay at the bedside while his father is confused. When developing the plan of care for this patient, what should the nurse do?

Correct Answer: D

Rationale: The correct answer is D: Involve the son in the plan of care as much as possible. This is important for several reasons. Firstly, involving the son promotes family-centered care, which can improve patient outcomes. Secondly, the son may provide valuable insights into the patient's preferences and needs. Thirdly, it can help reduce the patient's confusion by providing familiar support. Option A is incorrect as it disregards the potential benefits of involving family members. Option B is incorrect as it focuses on the patient's rest without considering the emotional support the son may provide. Option C is incorrect as it assumes the gender of the family member matters more than their relationship to the patient.

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