ATI RN Fundamentals 2023 | Nurselytic

Correct Answer: A

Rationale: The correct answer is A: Metabolic syndrome. Metabolic syndrome is a cluster of conditions that increase the risk of cardiovascular disease, including high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. These factors contribute to a higher likelihood of developing heart disease, stroke, and other cardiovascular issues.


Choice B, participation in competitive sports, does not inherently place a client at risk for cardiovascular disease; in fact, regular exercise is beneficial for heart health.
Choice C, family history of alcohol use disorder, may indicate a genetic predisposition to alcoholism but is not directly linked to cardiovascular disease risk.
Choice D, hypotension, is low blood pressure and is not typically associated with an increased risk of cardiovascular disease.

Correct Answer: B

Rationale: The correct answer is B: Place an activated tuning fork in the middle of the client's forehead. This is the appropriate action for the Weber's test because it helps determine if there is a conductive or sensorineural hearing loss. Placing the tuning fork on the forehead allows the sound to be conducted through bone to both cochleae simultaneously. If the client hears the sound equally in both ears, it suggests normal hearing or symmetrical hearing loss. If the client hears the sound louder in one ear, it indicates conductive hearing loss in that ear.


Choice A is incorrect because random high-pitched sounds do not specifically test for conductive vs. sensorineural hearing loss.
Choice C is incorrect because the tuning fork should be placed on the forehead, not the mastoid process, for the Weber's test.
Choice D is incorrect as whispering words does not test for conductive vs. sensorineural hearing loss.

Correct Answer: C

Rationale: The correct answer is C because it acknowledges the client's feelings and shows empathy. By reflecting the client's concern about the future, the nurse validates their emotions and opens up the opportunity for further discussion and support. Option A minimizes the client's concerns, B dismisses their feelings, and D is confrontational and may make the client feel judged.
Therefore, choice C is the most therapeutic response as it promotes a trusting nurse-client relationship.

Correct Answer: B

Rationale:
Correct
Answer: B - Ensure the client's heels are not touching the mattress.


Rationale: Keeping the client's heels off the mattress reduces pressure on this vulnerable area, decreasing the risk of developing pressure injuries. Pressure injuries commonly occur on bony prominences like the heels, making option A incorrect. Raising the head of the bed does not directly address pressure injury prevention, so option C is not the best choice. Repositioning every 4 hours is important but may not be sufficient to prevent pressure injuries, making option D less effective than ensuring the heels are off the mattress.

Correct Answer: A,C

Rationale: The correct answers are A and C. Option A is important as adjusting oxygen flow rate can help ease breathing, ensuring optimal oxygen delivery. Option C advises storing the oxygen cylinder wrench with the tank for easy access in case of emergencies. These two pieces of information are crucial for maintaining proper oxygen therapy and ensuring safety.

Options B, E, F, and G are incorrect. Option B states a specific duration for antibiotic therapy, which may vary depending on the type of infection. Option E relates to steroid medication administration timing, which can vary based on the specific medication and condition. Option F provides general advice on antibiotic administration but may not apply to all antibiotics. Option G implies a specific tapering schedule for steroids, which should be individualized based on the patient's condition and response.