ATI RN
ATI Capstone Week 10 Exam Questions
Extract:
Question 1 of 5
A nurse is providing teaching to a client who has a new diagnosis of Ménière’s disease. Which of the following instructions should the nurse include in the teaching?
Correct Answer: B
Rationale: The correct answer is B: Avoid sudden movements. This instruction is important for a client with Ménière’s disease because sudden movements can trigger vertigo, a common symptom of the condition. By avoiding sudden movements, the client can reduce the risk of experiencing vertigo episodes.
A: Avoid bearing down - This is not directly related to managing Ménière’s disease symptoms.
C: Increase sodium intake - Increasing sodium intake can worsen symptoms of Ménière’s disease as it can lead to fluid retention and increased pressure in the inner ear.
D: Increase caffeine intake - Caffeine is a known trigger for vertigo in individuals with Ménière’s disease, so increasing caffeine intake would not be advisable.
Question 2 of 5
A nurse is monitoring a client who has experienced anaphylactic shock. Which manifestations are associated with this condition? (Select all that apply.)
Correct Answer: B,C,D,F
Rationale: The correct manifestations associated with anaphylactic shock are chest pain, dyspnea, angioedema, and urticaria. Chest pain can result from decreased oxygen delivery to the heart due to decreased blood flow. Dyspnea is caused by bronchoconstriction and swelling of the airways. Angioedema is the swelling of deeper layers of the skin, often around the eyes or lips. Urticaria is the appearance of hives or raised, red, itchy welts on the skin. Increased awareness and hypertension are not typically associated with anaphylactic shock.
Therefore, choices A and E are incorrect.
Question 3 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.
Question 4 of 5
A nurse is instructing the caregiver of a child who has bacterial conjunctivitis and a new prescription for an ophthalmic ointment. Which of the following instructions should the nurse provide?
Correct Answer: A
Rationale:
Correct Answer: A
Rationale: Applying the ointment in a thin line into the conjunctival sac ensures proper distribution and maximum absorption. This method prevents contamination and minimizes wastage. It also allows the medication to stay in contact with the affected area for a longer period, enhancing its therapeutic effect.
Summary of Incorrect
Choices:
B: Asking the child to look down is unnecessary and not relevant to the application of ointment into the conjunctival sac.
C: Using a sterile glove and applicator may be recommended in certain situations, but it is not essential for applying ophthalmic ointment in this case.
D: Wiping from the outer to the inner canthus when wiping away secretions is unrelated to the correct application of ophthalmic ointment for bacterial conjunctivitis.
Question 5 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.