ATI RN
ATI Nurse 142 Final Questions
Extract:
Question 1 of 5
When assessing the anus, the nurse should inspect for: (Select all that apply)
Correct Answer: A,B,C
Rationale: When assessing the anus, the nurse should inspect for bleeding, hemorrhoids, and pain, as these are directly observable or reportable during an anal examination. Prostate enlargement is not directly assessed through an anal examination, as it requires a digital rectal exam, typically performed by a healthcare provider.
Question 2 of 5
The nurse is performing a nutritional assessment. Which of the following would be considered objective data?
Correct Answer: C
Rationale: Objective data are measurable and observable findings that can be obtained through physical examination, laboratory tests, or other diagnostic procedures. Body Mass Index (BMI) is a calculated value based on height and weight, making it objective. Dietary history, patient complaints, and history of alcohol intake are subjective as they rely on the patient's self-report and may not be entirely accurate.
Question 3 of 5
The patient has voided this am. the nurse will inspect the urine for which of the following?
Correct Answer: C
Rationale: The nurse inspects urine for clarity (to detect particles or bacteria), odor (to identify infections or conditions), and amount (to assess hydration and kidney function). Consistency, articulation, residual, and firmness are not applicable to urine inspection.
Question 4 of 5
When child, elder, or vulnerable adult abuse or neglect is disclosed, nurses:
Correct Answer: D
Rationale: Nurses are mandated reporters, legally required to report suspected or confirmed cases of child, elder, or vulnerable adult abuse or neglect to the appropriate authorities. This obligation supersedes other actions like involving family or referring to social services, which do not replace reporting.
Question 5 of 5
The nurse is checking for edema in the lower extremities of a patient with Congestive heart failure. The nurse will do which of the following when checking for edema. (Select all that apply)
Correct Answer: A,B
Rationale: When checking for edema in congestive heart failure, the nurse grades the edema on a scale of +1 to +4 based on the depth of pitting and presses the skin over the tibia to assess for pitting edema. Plantar flexing the feet is unrelated to edema assessment, and checking only one limb is insufficient as edema may occur bilaterally.