ATI RN
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Question 1 of 5
Which of the following statements about the outer layer of the eye is true?
Correct Answer: C
Rationale: The correct answer is C because the trigeminal (CN V) and the trochlear (CN IV) nerves are indeed stimulated when the outer surface of the eye is stimulated. The trigeminal nerve is responsible for the sensation of touch in the face and controls the muscles involved in chewing. The trochlear nerve controls the superior oblique muscle of the eye, which helps with downward and inward eye movements. Therefore, when the outer layer of the eye is touched or stimulated, these nerves are activated to convey the sensation to the brain. Choices A, B, and D are incorrect: A: The outer layer of the eye is not particularly sensitive to touch compared to other areas like the cornea or conjunctiva. B: The outer layer of the eye is not darkly pigmented; the pigmented layer is actually the uvea inside the eye. D: The visual receptive layer of the eye, known as the retina, is located deeper within the eye, not
Question 2 of 5
A physician has diagnosed a patient with purpura. After leaving the room, a nursing student asks the nurse what the physician saw that led to that diagnosis. The nurse should say:
Correct Answer: C
Rationale: The correct answer is C because purpura is characterized by the presence of confluent and extensive patches of petechiae and ecchymoses. Petechiae are small, pinpoint hemorrhages less than 2mm in size, and ecchymoses are larger bruises. This presentation is indicative of a more severe underlying condition, such as a bleeding disorder or vasculitis. Choice A is incorrect as it describes spider veins or telangiectasias, not purpura. Choice B describes a birthmark, not purpura. Choice D is incorrect as it describes petechiae, not purpura, which involves larger areas of bleeding.
Question 3 of 5
The mother of a 2-year-old is concerned because her son has had three ear infections in the past year. Which of the following would be an appropriate response by the nurse?
Correct Answer: D
Rationale: The correct answer is D because it provides an accurate explanation for the frequent ear infections in the 2-year-old. The eustachian tube in children is indeed shorter and wider compared to adults, making it easier for infections to develop. This anatomical difference predisposes young children to ear infections. Choice A is incorrect because it falsely implies that frequent ear infections in small children are unusual only if something else is wrong. Choice B is incorrect as checking the immune system is not typically the first step in addressing recurrent ear infections. Choice C is incorrect as cerumen (earwax) does not directly contribute to ear infections in the middle ear.
Question 4 of 5
During history-taking, a patient tells the nurse that he has frequent nosebleeds and asks about the best way to prevent them. What would be the nurse's best response?
Correct Answer: B
Rationale: The correct answer is B. When a patient experiences nosebleeds, the best way to stop it is by sitting straight with the head tilted slightly forward and pinching the nose firmly for about 10-15 minutes. This position helps reduce blood flow to the nose and promotes clotting. It is important not to tilt the head back as it can lead to blood going down the throat and potentially causing choking or vomiting. Cold compresses can also be applied to help constrict blood vessels. Choices A, C, and D are incorrect as they do not follow the proper technique for managing nosebleeds and can potentially worsen the situation.
Question 5 of 5
The nurse is unable to suction the nares of a newborn immediately following delivery. The attempt to pass a catheter through both nasal cavities has met with no success. What would be the nurse's best action in this situation?
Correct Answer: C
Rationale: Rationale for Correct Answer (C): 1. Immediate intervention is crucial as the newborn needs clear airways for breathing. 2. Inability to suction the nares can lead to respiratory distress and compromise the infant's oxygenation. 3. Waiting or attempting again may delay necessary actions, risking the baby's health. 4. Physician's assistance may be needed, but recognizing the urgency is the nurse's responsibility to ensure timely care. Summary of Incorrect Choices: A. Attempting to suction again with a bulb syringe may not resolve the issue and delay necessary intervention. B. Waiting for the infant to stop crying is not ideal as it may prolong the risk of respiratory distress. D. While physician assistance may be necessary, immediate recognition of the critical situation is the nurse's primary responsibility.
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