ATI RN
ATI RN Custom Nursing 221 Exam 4 Questions
Extract:
Question 1 of 5
A nurse is caring for a client who is postoperative and is at risk for developing venous thromboembolism (VTE). The nurse should instruct the client to avoid which of the following unsafe actions?
Correct Answer: B
Rationale: Massaging legs can dislodge a clot, increasing VTE risk.
Question 2 of 5
A nurse is caring for a client who has a traumatic brain injury. Which of the following findings should the nurse identify as an indication of increased intracranial pressure (ICP)?
Correct Answer: A
Rationale: Restlessness is an early sign of increased ICP due to brain pressure.
Question 3 of 5
A nurse is caring for a client who has had a stroke involving the right hemisphere. Which of the following alterations in function should the nurse expect?
Correct Answer: B
Rationale: Right hemisphere strokes often cause aphasia.
Question 4 of 5
A nurse in an emergency department is caring for a client who had a seizure and became unresponsive after stating she had a sudden, severe headache and vomiting. The client's vital signs are as follows: blood pressure of 198/110 mm Hg, pulse of 82/min, respirations of 24/min, and a temperature of 38.2° C (100.8° F). Which of the following neurologic disorders should the nurse suspect?
Correct Answer: A
Rationale: Sudden headache, vomiting, and high blood pressure suggest hemorrhagic stroke.
Question 5 of 5
During a routine physical examination, a nurse observes a 1-cm (0.4-in) lesion on a client's chest. The lesion is raised and flesh-colored with pearly white borders. The nurse should recognize that this finding is suggestive of which of the following types of skin cancer?
Correct Answer: A
Rationale: Basal cell carcinoma presents as a raised, flesh-colored lesion with pearly borders.