ATI RN
ATI RN Fundamentals Online Practice 2023 B Questions
Extract:
Nurses' Notes
The pressure injury on the sacrum was covered with slough and eschar. Debridement was performed.
The pressure injury was malodorous and at stage 4 with two tunnels present.
The pressure injury measured 10 cm (4 in) in diameter and 3 cm (1.2 in) at the deepest point.
The tunneling locations were at one and eight o’clock and measured at 6 cm (24 in) and 4 cm (1.6 in) respectively. The wound care nurse initiated negative pressure wound therapy.
Today, the client was sitting in bed, alert and oriented x. The client stated, “I can’t wait to get this thing off of me.”. The client reported pain as a 5 on a scale of 0 to 10. A PRN analgesic was prescribed.
At 0830, the client’s condition was assessed.
The client was at the bedside for a dressing change. S1 and S2 were auscultated, with a rate of 76/min. Respirations were even and regular at 16/min.
The negative pressure wound therapy dressing was removed.
Granulation tissue covered the wound bed. There was slight erythema.
The pressure injury measured 8.75 cm (3.5 in) in diameter and 2.5 cm (1 in) at the deepest point.
Two tunnels measured 5 cm (2 in) and 3 cm (1.2 in). The dressing was reapplied and sealed, with an intermittent pressure setting at 125 mm Hg. The client reported pain as a 2 on a scale from 0 to 10 and tolerated the procedure well.
Question 1 of 5
Three days ago, a client was admitted from home with a reported pressure injury. The provider and wound care nurse were at the bedside. Which statement best describes the most critical aspect of the client's pressure injury and current treatment?
Correct Answer: B
Rationale: The correct answer is B: The pressure injury was at stage 4. This is the most critical aspect because stage 4 pressure injuries are the most severe, involving extensive tissue damage. Immediate and appropriate treatment is crucial to prevent further complications and promote healing.
Choice A is not as critical because the timing of admission does not directly impact the urgency of treating a stage 4 pressure injury.
Choice C, the client's pain level, though important, is not the most critical aspect as pain can vary among individuals and may not always correlate with the severity of the injury.
Choice D, the dressing being reapplied, is a part of the treatment process but not the most critical aspect compared to identifying the stage of the pressure injury.
Extract:
A client with herpes zoster is inquiring about the use of complementary and alternative therapies for pain management.
Question 2 of 5
Which therapy should the nurse inform the client is contraindicated for their condition?
Correct Answer: D
Rationale: The correct answer is D: Acupuncture. Acupuncture involves inserting thin needles into specific points on the body to alleviate various conditions. However, for some clients with certain medical conditions like bleeding disorders or compromised immune systems, acupuncture can be contraindicated due to the risk of infection or excessive bleeding.
Therefore, the nurse should inform the client that acupuncture is not suitable for their condition.
A: Biofeedback is a non-invasive technique that helps individuals control physiological processes. It is generally safe and not contraindicated for most clients.
B: Aloe is a natural remedy often used for skin conditions or as a dietary supplement. It is generally safe and not contraindicated for most clients.
C: Feverfew is an herb commonly used for migraines and other conditions. While it may interact with certain medications, it is not typically contraindicated for most clients.
Extract:
A nurse is providing discharge instructions to a patient who has a new prescription for a home oxygen concentrator.
Question 3 of 5
Which of the following instructions should the nurse provide to the patient and their family?
Correct Answer: A,B,C,D
Rationale: The correct instructions for the patient and family are important for safety and health.
A: Regularly inspecting the cord prevents electrical hazards. B: Keeping the unit away from a gas stove prevents fire hazards. C: Having a generator ensures power backup during emergencies. D: Monitoring for hypoxia is crucial for early intervention.
Incorrect: E: Clothing choice is unrelated to the instructions.
Extract:
A nurse is planning a teaching session for a group of adolescents who each recently had an ostomy surgically placed.
Question 4 of 5
Which of the following methods should the nurse use as a psychomotor approach to learning?
Correct Answer: D
Rationale: The correct answer is D: Role play. Role play is a psychomotor approach to learning because it involves physical movement and practice of real-life scenarios, enhancing hands-on skills and muscle memory. It allows learners to actively participate, engage in problem-solving, and apply theoretical knowledge to practical situations. Group discussions (
A) focus on cognitive learning through dialogue. Query answer meetings (
B) involve verbal exchanges rather than physical actions. Practice sessions (
C) may involve repetition but lack the interactive and immersive nature of role play.
Extract:
Question 5 of 5
The client’s chest x-ray shows lung hyperinflation and left upper lobe pneumonia. What is the most likely diagnosis?
Correct Answer: C
Rationale: The most likely diagnosis is pneumonia (
Choice
C) because the client's chest x-ray shows lung hyperinflation and left upper lobe pneumonia. Lung hyperinflation can result from air trapping in the lungs, commonly seen in pneumonia. Left upper lobe pneumonia typically presents with symptoms such as cough, fever, and chest pain. Tuberculosis (
Choice
A) would typically present with different radiographic findings like cavitary lesions. Bronchitis (
Choice
B) presents with inflammation of the bronchial tubes, not hyperinflation. Asthma (
Choice
D) would show signs of reversible airway obstruction, not hyperinflation.