ATI RN
ATI Capstone Week 10 Exam Questions
Extract:
Question 1 of 5
A nurse is assessing a client for conductive hearing loss. When using the Rinne test, which of the following results should the nurse identify as an indication that the client has conductive hearing loss of the left ear?
Correct Answer: D
Rationale: The correct answer is D: Air conduction is less than bone conduction in the left ear. In conductive hearing loss, there is a problem conducting sound waves through the outer or middle ear. During the Rinne test, the tuning fork is first placed on the mastoid process behind the ear to test bone conduction. If the client has conductive hearing loss in the left ear, bone conduction will be better than air conduction when the tuning fork is placed near the ear canal. This indicates that the sound is better conducted through the bone (mastoid) than through the air (ear canal), confirming conductive hearing loss in the left ear.
Incorrect choices:
A: Sound is lateralizing to the right ear - This is not indicative of conductive hearing loss.
B: Sound is lateralizing to the left ear - Lateralization does not provide information about conductive hearing loss.
C: Air conduction is greater than bone conduction in the left ear - This result
Question 2 of 5
The nurse is creating a plan of care for a client diagnosed with Sjögren’s syndrome. Which interventions should the nurse incorporate in the plan for this client?
Correct Answer: C
Rationale: The correct answer is C: Use of artificial tears. Sjögren’s syndrome is an autoimmune disorder that primarily affects the salivary and lacrimal glands, leading to dry eyes and dry mouth. Using artificial tears helps to alleviate dryness and discomfort in the eyes. This intervention is crucial in managing the symptoms of Sjögren’s syndrome.
Other choices are incorrect because:
A: Silicone-based vaginal lubricants are not directly related to managing the symptoms of Sjögren’s syndrome.
B: While using dehumidifiers may help with dryness in the environment, it does not directly address the dry eyes associated with Sjögren’s syndrome.
D: Using contact lenses may exacerbate dry eye symptoms in individuals with Sjögren’s syndrome.
Question 3 of 5
A nurse is admitting a client who has a partial hearing loss. Which of the following is the priority action by the nurse?
Correct Answer: B
Rationale: The correct answer is B because determining if the client uses hearing aids is crucial to facilitate effective communication and ensure the client's needs are met. By knowing if the client uses hearing aids, the nurse can adjust communication strategies accordingly. Rephrasing statements (
A) is helpful but not the priority. Speaking directly in front of the client (
C) may not be sufficient for optimal communication. Using hand gestures (
D) may not be effective if the client relies on hearing aids.
Question 4 of 5
A nurse is caring for a client who is HIV positive and is one day postoperative following an appendectomy. The nurse should wear a gown as personal protective equipment when taking which of the following actions?
Correct Answer: B
Rationale: The correct answer is B: Completing a dressing change. When performing a dressing change on a postoperative client who is HIV positive, there is a risk of exposure to the client's blood or bodily fluids. Wearing a gown as personal protective equipment helps to protect the nurse from potential contact with infectious materials during the procedure. Administering an IM injection (choice
A) typically does not require a gown unless there is a risk of splashing. Administering an intermittent IV bolus medication (choice
C) may require gloves but not necessarily a gown. Talking to the client at the bedside (choice
D) does not warrant the use of a gown unless there is a specific risk of exposure to bodily fluids during the conversation.
Question 5 of 5
A client arrives at the health care clinic and tells the nurse that she was just bitten by a tick and would like to be tested for Lyme disease. Which nursing action is appropriate?
Correct Answer: C
Rationale: The correct answer is C: Refer the client for a blood test immediately. This is appropriate because Lyme disease is diagnosed through blood tests, specifically the enzyme-linked immunosorbent assay (ELIS
A) and Western blot tests. By referring the client for a blood test immediately, the nurse can accurately assess for the presence of Lyme disease. Options A and B are incorrect as testing the tick itself is not necessary for diagnosing Lyme disease. Option D is unnecessary as the size and color of the tick do not impact the diagnosis or treatment of Lyme disease.