ATI RN
Multi Dimensional Care | Exam | Rasmusson
1. A client on bed rest complains of pain and burning in the right calf area. What is the nurse's action?
- A. Deeply palpate the area for rebound tenderness
- B. Medicate the client for pain and reassess in 60 minutes
- C. Percuss over the area for a change in tone
- D. Compare the circumference to the left calf
Correct answer: D
Rationale:
2. A client is bedridden and appears to be frail and malnourished. Which nursing interventions will increase the risk of pressure injury?
- A. Applying moisturizer to dry areas of the skin
- B. Massaging the client's reddened shoulders and heels
- C. Cleansing the skin routinely after soiling occurs
- D. Using a Hoyer lift for all transfers
Correct answer: B
Rationale:
3. The client asks the nurse what nonpharmacological intervention can be used to reduce pain and swelling in her joints affected by rheumatoid arthritis. What is the most appropriate response by the nurse?
- A. "Ice packs can be used to reduce swelling but should be removed after 20 minutes."?
- B. "Heat always makes the swelling go down. You do not need any other interventions."?
- C. "Try high impact exercise exercise like running to loosen up your joints and reduce pain."?
- D. "Apply ice packs. It is generally okay to keep them on for up to one hour at a time."?
Correct answer: A
Rationale:
4. A nurse working in an orthopedic unit is caring for 4 clients. Which of the following clients should the nurse identify as being at highest risk for skin breakdown?
- A. An adolescent who has a patella fracture and is in an immobilizer
- B. A young adult who has a femur fracture and is going to surgery in two hours
- C. A middle-aged adult who has fractured his radius and has a cast
- D. An older adult who has a hip fracture and is immobile
Correct answer: D
Rationale:
5. What medication class can decrease tissue in inflammation but delays bone healing?
- A. Opioids
- B. Anticoagulants
- C. Narcotics
- D. Nonsteroidal anti-inflammatory drugs (NSAIDS)
Correct answer: D
Rationale:
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