ATI RN
ATI Capstone Week 11 Exam Questions
Extract:
Question 1 of 5
A nurse is providing home safety information for an older adult client who uses a cane. Which of the following statements should the nurse include in the teaching?
Correct Answer: D
Rationale:
Correct Answer: D - You should advance your weak leg forward to the cane, then move your strong leg.
Rationale: By advancing the weak leg first, the client's center of gravity is more stable, reducing the risk of falls. Moving the strong leg next provides additional support and balance. This sequence ensures proper weight distribution and minimizes the risk of tripping or losing balance.
Summary of Incorrect
Choices:
A: Advancing the cane too far ahead can lead to imbalance and potential falls.
B: Holding the cane in the weak hand may not provide adequate support and stability.
C: The cane's height should align with the wrist crease, not the mid flank, for proper use and support.
Question 2 of 5
A nurse is assessing a client who is in active labor and notes that the presenting part is at 0 station. Which of the following is the correct interpretation of this clinical finding?
Correct Answer: C
Rationale: Answer C is correct because at 0 station, the lowermost portion of the fetus is at the level of the ischial spines. This indicates that the baby's head has descended to the level of the maternal ischial spines, which is a significant position in the birthing process. This is a key landmark for monitoring progress during labor.
Option A is incorrect because passing through the pelvic outlet is not the same as being at 0 station. Option B is incorrect because the palpability of the posterior fontanel is unrelated to station. Option D is incorrect because the fetal head position is not specified in the station measurement.
Question 3 of 5
A nurse is instructing clients in the community about relationship development. The nurse should explain that, according to Erikson, establishing relationships with commitment is a primary task of which of the following stages of psychosocial development?
Correct Answer: D
Rationale: The correct answer is D: Intimacy vs. isolation. In Erikson's psychosocial theory, this stage occurs in young adulthood, where individuals focus on developing intimate relationships based on mutual trust and commitment. This stage is characterized by the desire to form strong, lasting bonds with others.
Choice A, generativity vs. stagnation, focuses on the middle adulthood stage where individuals are concerned with contributing to society and nurturing the next generation.
Choice B, identity vs. role diffusion, pertains to adolescence and the struggle to establish a sense of self and direction.
Choice C, trust vs. mistrust, is the first stage in infancy where the focus is on developing a sense of trust in the world.
Question 4 of 5
Which findings are normal age-related physiological changes? Select all that apply.
Correct Answer: A,B,D,E
Rationale: The correct answers are A, B, D, and E.
A: Decline in long-term memory is a normal age-related change due to the natural aging process affecting cognitive functions.
B: Diminished visual acuity is common as the eye's lens becomes less flexible with age.
D: Decreased stress response is normal as the body's ability to handle stress weakens with age.
E: Increased susceptibility to urinary tract infections is a result of changes in the urinary system due to aging.
Choices C, F, and G are incorrect as increased heart rate is not a typical age-related change, and options F and G are not provided.
Question 5 of 5
A nurse in the labor and delivery unit is caring for a client who is undergoing external fetal monitoring. The nurse observes that the fetal heart rate begins to slow after the start of a contraction, and the lowest rate occurs after the peak of the contraction. Which of the following actions should the nurse take first?
Correct Answer: A
Rationale: The correct answer is A: Place the client in the lateral position. This action helps improve maternal perfusion and oxygenation to the fetus by increasing blood flow to the placenta. Placing the client in the lateral position can alleviate compression on the vena cava, which may be causing the fetal heart rate deceleration. Elevating the client's legs (
B) may not directly address the issue of decreased perfusion. Increasing the rate of maintenance IV infusion (
C) may not be necessary if the vena cava compression is the cause. Administering oxygen using a nonrebreather mask (
D) may be indicated if the fetal heart rate deceleration persists, but placing the client in the lateral position should be the initial intervention.