ATI RN
Multi Dimensional Care | Exam | Rasmusson
1. A client is in the emergency room in critical condition and hypotensive. Her spouse is distraught. What is the priority nursing action?
- A. Maintain the client's blood pressure
- B. Call a chaplain
- C. Provide the spouse a chair
- D. Ask the client's spouse to explain what happened
Correct answer: A
Rationale:
2. A nurse is caring for an immobile client. What is the priority assessment of this client?
- A. Palpate for edema
- B. Auscultate for bowel sounds
- C. Inspect the skin for injury
- D. Auscultation of lung sounds
Correct answer: C
Rationale: Inspecting the skin for injury is crucial to prevent pressure ulcers and other complications in immobile clients.
3. The nurse is providing medication for a client with osteomyelitis. What teaching should the nurse indicate in the education?
- A. The most common adverse e effect for nonsteroidal anti-inflammatory drugs (NSAIDS)are liver failure and tinnitus
- B. The main side effect of acetaminophen is gastrointestinal GI bleeding
- C. You should not take more than 4000 mg of acetaminophen a day
- D. Nonsteroidal anti-inflammatory drugs (NSAIDS) are very safe and are known to have no side effects
Correct answer: A
Rationale:
4. What nursing intervention is appropriate for a client with systemic lupus erythematous (SLE)?
- A. Intense cold therapy to the extremities
- B. Encourage ultraviolet (UV) light exposure
- C. Administer topical hydrocortisone
- D. Administer antibiotics
Correct answer: C
Rationale:
5. What is a sign of inadequate perfusion?
- A. Intact sensation
- B. Pallor in toes
- C. Bounding pulses
- D. Pink fingers
Correct answer: B
Rationale:
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