ATI RN
Transcultural Concepts in Nursing Care 7th Edition Test Bank Questions
Question 1 of 9
Which physiological changes associated with aging increase the risk of hypertension in older adults?
Correct Answer: A
Rationale: As individuals age, there is a natural increase in systolic blood pressure (the top number in a blood pressure reading). This rise is attributed to factors such as arterial stiffness, reduced compliance of blood vessels, and decreased elasticity of the arteries. This increase in systolic blood pressure with age is considered a significant risk factor for hypertension in older adults. Hypertension is commonly defined as having a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher. Therefore, the age-related increase in systolic blood pressure contributes to the overall risk of developing hypertension in the elderly population.
Question 2 of 9
A nurse is caring for a group of clients who are recovering in a rehabilitation hospital following total hip replacements. Which client is exhibiting the highest motivation to learn?
Correct Answer: C
Rationale: The client who is excited to learn ambulation techniques (Option C) is exhibiting the highest motivation to learn. This client's enthusiasm for learning new skills related to ambulation indicates a strong willingness to actively engage in their rehabilitation process. Learning ambulation techniques is a crucial aspect of recovery following a total hip replacement, as it helps improve mobility and independence. The excitement to learn demonstrates that this client is eager to participate in their rehabilitation and is likely to be more proactive in achieving their recovery goals.
Question 3 of 9
The community nurse is preparing a presentation on Lyme disease for community members. What should the nurse explain about the spread of the organism for this disease?
Correct Answer: C
Rationale: Lyme disease is primarily spread through the bite of an infected black-legged tick, also known as a deer tick. The tick must be infected with the bacterium Borrelia burgdorferi in order to transmit the disease. Contrary to popular belief, the tick doesn't transmit the infection immediately upon biting. Borrelia burgdorferi is typically transmitted after the tick has been attached to the host for at least 24 hours. This gives individuals a window of time to remove attached ticks before transmission occurs. Therefore, the most accurate statement regarding the spread of the organism for Lyme disease is through an infected tick that has been embedded for more than 24 hours.
Question 4 of 9
The nurse is auscultating heart sounds for a pregnant client in the third trimester of pregnancy. The client wants to know why her doctor told her she had an extra heart sound at the last visit. Which response by the nurse is appropriate?
Correct Answer: C
Rationale: During pregnancy, it is not uncommon for women to have an extra heart sound known as a gallop rhythm. This is often referred to as a ventricular gallop, which is the presence of an S3 heart sound. In pregnant women, the increased blood volume and changes in heart dynamics can lead to the development of this extra sound. It is considered a normal finding during the third trimester of pregnancy and is usually not a cause for concern. It is important for healthcare providers to differentiate between normal physiological changes associated with pregnancy and potential heart abnormalities, which is why a ventricular gallop in this context is typically considered a benign finding.
Question 5 of 9
The nurse is planning care for a client admitted with a cardiac dysrhythmia. Which action would be the most appropriate for this client?
Correct Answer: C
Rationale: Monitoring serum electrolyte levels would be the most appropriate action for a client admitted with a cardiac dysrhythmia. Electrolyte imbalances, particularly potassium and magnesium, can lead to cardiac dysrhythmias. Therefore, it is crucial to monitor and maintain proper electrolyte levels to prevent or manage dysrhythmias. Restricting fluids, encouraging bedrest, or instructing in a low-fat diet are not the priority actions for managing a cardiac dysrhythmia.
Question 6 of 9
An older patient is experiencing constipation. What should the nurse teach this patient to help with this health problem? Select all that apply.
Correct Answer: A
Rationale: A. Eating a bran cereal for breakfast is a good dietary recommendation for managing constipation because bran is high in fiber, which helps promote regular bowel movements by adding bulk to the stool.
Question 7 of 9
The nurse is caring for a client who has had a myocardial infarction. The client states, "I have been smoking for 35 years, what good will quitting do?" Which response is best?
Correct Answer: A
Rationale: The best response is "Your risk of continued coronary artery disease will decrease by half when you stop." This response provides a specific and concrete benefit of quitting smoking for the client with a history of myocardial infarction. By explaining that quitting smoking can reduce the risk of continued coronary artery disease by half, the nurse is providing motivation and encouragement for the client to make a positive change in their lifestyle. This information is factual and can help the client understand the immediate benefits of quitting smoking in relation to their current health condition.
Question 8 of 9
During a 6-month well-baby check up, the mother mentions to the nurse that her infant seems to be sleeping just as much as she did as a newborn, and she seems to do everything with her left hand. The nurse recognizes that these are warning signs of stroke that occurred early in life. What other question should the nurse ask to assess for signs of stroke?
Correct Answer: A
Rationale: Jerking movements in the face, arms, or legs can be a sign of seizures, which can occur as a result of a stroke in infants. This question is important to assess whether the infant may have experienced any seizure activity, which could indicate a potential stroke. It helps the nurse gather more information to understand the infant's symptoms and assess the possibility of a stroke event.
Question 9 of 9
A patient has difficulty getting to the bathroom in time to prevent urine leaks once the need to void occurs. What should the nurse teach this patient?
Correct Answer: B
Rationale: Establishing a voiding schedule that includes emptying the bladder at least every 2 hours can help prevent urine leaks in this patient. By regularly emptying the bladder, the patient can reduce the likelihood of urgency and leakage episodes. This strategy helps in managing the symptoms of urge incontinence or overactive bladder, which seem to be the underlying issues for the patient described in the scenario. The other options may also be helpful in managing urinary incontinence but creating a voiding schedule is the most direct and effective approach for the patient's specific concern.