ATI RN
Multi Dimensional Care | Exam | Rasmusson
1. A goal for a client with impaired mobility is to prevent skin breakdown. What nursing intervention would best help the client meet this goal?
- A. Assist the client to orthopneic position
- B. Offer the client a bedpan for toileting
- C. Offer a protein-rich diet
- D. Turn the client every 2 hours
Correct answer: D
Rationale:
2. The nurse is caring for a client with rheumatoid arthritis one day after shoulder surgery. What would prompt the nurse to call the provider immediately?
- A. The client refused her pain medication this morning and is doing physical therapy.
- B. The client reports a minor headache and states she takes an over-the-counter pain pill at home.
- C. The client reports intermittent flatus and minor abdominal discomfort.
- D. The client has paresthesia in her fingers and intense increasing pain in her shoulder.
Correct answer: D
Rationale: In a client with rheumatoid arthritis one day after shoulder surgery, paresthesia in the fingers and intense increasing pain in the shoulder could indicate nerve compression or damage, which are serious post-operative complications. This situation requires immediate attention from the provider to prevent further complications and ensure appropriate management. The other options, such as refusing pain medication, reporting a minor headache, or experiencing minor abdominal discomfort, are important but not as urgent or indicative of potential serious complications as paresthesia in the fingers and intense increasing pain in the shoulder.
3. Which nonpharmacological intervention does not help reduce edema?
- A. Heat therapy
- B. Passive range of motion (PROM)
- C. Elevation of the extremity
- D. Cold therapy
Correct answer: A
Rationale: The correct answer is A: Heat therapy. Heat therapy can vasodilate blood vessels, increasing blood flow to the area and potentially exacerbating edema. Passive range of motion (PROM), elevation of the extremity, and cold therapy are all beneficial interventions for reducing edema. PROM helps with circulation, elevation assists in reducing fluid accumulation, and cold therapy can help constrict blood vessels and decrease swelling.
4. What is the most common method of reducing and immobilizing a fracture?
- A. Open reduction with external fixation
- B. External reduction and internal fixation
- C. External fixation with closed reduction
- D. Open reduction with internal fixation
Correct answer: D
Rationale: Open reduction with internal fixation (ORIF) is the most common method for reducing and immobilizing fractures.
5. A client is diagnosed with systemic sclerosis (scleroderma). What symptoms is the first to occur?
- A. Tachycardia
- B. Raynaud's phenomenon
- C. Intense wrinkle
- D. Joint pain
Correct answer: B
Rationale:
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