ATI RN
ATI Nutrition Practice Test A 2019
1. What is the purpose of a chest tube after a lobectomy procedure, as understood by the nurse?
- A. Prevent mediastinal shift
- B. Promote chest expansion of the remaining lung
- C. Drain fluids and blood accumulated post-operatively
- D. Remove the air in the lungs to promote lung expansion
Correct answer: C
Rationale: After a lobectomy, a chest tube is typically inserted to drain fluids and blood that may have accumulated post-operatively. This tube helps to prevent complications, such as infections or pneumonia, and aids in patient recovery. While a chest tube may aid in preventing a mediastinal shift (Choice A), promoting chest expansion of the remaining lung (Choice B), and removing air in the lungs to promote lung expansion (Choice D), these are not the primary reasons for its use after a lobectomy. Therefore, Choices A, B, and D are incorrect.
2. What is the primary function of a written nursing care plan?
- A. Evaluates whether nursing care goals have been achieved
- B. Ensures the provision of quality nursing care
- C. Assists in selecting the appropriate nursing interventions
- D. Facilitates the creation of a nursing diagnosis
Correct answer: D
Rationale: A written nursing care plan fundamentally serves to facilitate the development of a nursing diagnosis. This procedure involves analyzing patient data and identifying health problems that nurses can address independently. This analysis then aids in determining the most appropriate nursing interventions for the identified health issues. Although evaluating the achievement of nursing care goals is an important aspect, it is not the primary function of a nursing care plan. Similarly, while delivering quality nursing care is crucial, it is a broader concept that includes many other facets beyond just the initial nursing diagnosis and interventions.
3. Which of the following interventions should be considered the highest priority when caring for June, who has hemiparesis secondary to a stroke?
- A. Position June in an upright lateral position
- B. Perform range of motion exercises
- C. Apply antiembolic stockings
- D. Use hand rolls or pillows for support
Correct answer: C
Rationale: The correct answer is C, 'Apply antiembolic stockings'. In the case of a patient who has experienced a stroke and is suffering from hemiparesis, the highest priority intervention is to prevent further complications such as deep vein thrombosis (DVT), which can be life-threatening. Antiembolic stockings are used to increase venous blood flow velocity and reduce the risk of DVT. Choice 'A', positioning June in an upright lateral position, while important for overall care, is not the highest priority. Choice 'B', performing range of motion exercises, is an important part of recovery but not the immediate priority. Choice 'D', using hand rolls or pillows for support, is also a valuable intervention but does not address the most pressing risk of further complications.
4. In which of the following conditions does a person need to sit, stand, or use multiple pillows when lying down?
- A. Orthopnea
- B. Dyspnea
- C. Eupnea
- D. Apnea
Correct answer: A
Rationale: The correct answer is Orthopnea. Orthopnea is a medical condition in which a person has difficulty breathing while lying down. To alleviate this difficulty, the person may need to sit, stand, or use multiple pillows. On the other hand, Dyspnea refers to general shortness of breath which is not specifically related to the position of the body. Eupnea is the term for normal, unlabored breathing, and Apnea is a condition characterized by the cessation of breathing. Thus, none of these other choices directly relate to the need to adjust body position or use aids like multiple pillows to breathe comfortably when lying down.
5. 24 hours after the creation of a colostomy, what should Nurse Violy identify as the normal appearance of the stoma?
- A. Pink, moist, and slightly protruding from the abdomen
- B. Gray, moist, and slightly protruding from the abdomen
- C. Pink, dry, and slightly protruding from the abdomen
- D. Red, moist, and slightly protruding from the abdomen
Correct answer: A
Rationale: Following colostomy surgery, a healthy stoma should appear pink, moist, and slightly protruding from the abdomen, which is why option 'A' is the correct answer. A gray stoma (choice 'B') could indicate poor blood supply or necrosis, which is a serious complication. A dry stoma (choice 'C') is also not normal as it should be moist; a dry stoma may suggest dehydration or other complications. While a stoma can appear red (choice 'D'), this is not typically the normal color; it should usually be pink. Therefore, it's important for healthcare professionals to correctly identify the normal and abnormal appearances of a stoma to ensure proper patient care.
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