ATI RN
Multi Dimensional Care | Final Exam
1. A client does not understand why vision loss due to glaucoma is irreversible. What is the best explanation?
- A. Once bacterial infection has caused damage, the tissue does not regenerate.
- B. Once retinal detachment occurs, it does not return to its normal state.
- C. Too many nerve fibers have become ischemic and died, so vision loss is permanent.
- D. Glaucoma always leads to permanent blindness.
Correct answer: C
Rationale: The correct answer is C. In glaucoma, the optic nerve damage due to high intraocular pressure leads to permanent vision loss because the nerve fibers do not regenerate. Choice A is incorrect as it discusses bacterial infection, not relevant to glaucoma. Choice B is incorrect because it refers to retinal detachment, not glaucoma. Choice D is incorrect because not all glaucoma cases lead to permanent blindness; vision loss can be prevented or slowed with treatment.
2. The nurse has documented the following wound assessment. "Shallow, open, reddened ulcer with no slough on the anterior region of the right heel?"? what stage is the wound?
- A. Stage 3
- B. Stage 4
- C. Stage 1
- D. Stage 2
Correct answer: D
Rationale:
3. A nurse is caring for an immobile client. What is the priority assessment in this client?
- A. Auscultation of lung sounds
- B. Assessment of skin turgor
- C. Auscultation of bowel sounds
- D. Assessment for the presence of peripheral edema
Correct answer: A
Rationale:
4. What does CREST stand for?
- A. Calcinosis, Raynaud's, Esophageal dysmotility, Sclerodactyly and Telecines
- B. Calcinosis, Reverse isolation, Esophageal dysmotility, Sclerodactyly and Telangiectasia
- C. Calcinosis, Raynaud's, Everted colon, Sclerodactyly and Telangiectasia
- D. Calcinosis, Raynaud's Esophageal dysmotility, Sclerodactyly and telangiectasia
Correct answer: D
Rationale:
5. A client has a new diagnosis of human immunodeficiency virus HIV. The client is distraught and does not know what to do. What intervention by the nurse is the best?
- A. Offer to tell the family for the client
- B. Call the hospital clergy to speak with the client
- C. Assess the client's support system
- D. Explain the legal requirements to tell sex partners
Correct answer: C
Rationale:
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