ATI RN
ATI Capstone Adult Medical Surgical Assessment 1
1. A nurse in a rural community center is providing education to a group of clients about first aid interventions for snake bites. Which of the following instructions should the nurse include in the teaching?
- A. Apply an ice pack directly to the affected area
- B. Immobilize the affected extremity with a splint
- C. Place a tourniquet above and below the affected area
- D. Elevate the affected extremity
Correct answer: B
Rationale: The correct answer is to immobilize the affected extremity with a splint. This helps to slow the spread of venom by limiting movement. Applying an ice pack directly to the affected area (Choice A) is not recommended for snake bites as it could exacerbate tissue damage. Placing a tourniquet above and below the affected area (Choice C) is also not advised as it can lead to further complications. Elevating the affected extremity (Choice D) is not recommended for snake bites; keeping it below the level of the heart is more appropriate to reduce venom spread.
2. Skin care around the stoma is critical. Which of the following is not indicated as a skin care barriers?
- A. Apply liberal amount of mineral oil to the area
- B. Use karaya paste and rings around the stoma
- C. Clean the area daily with soap and water before applying bag
- D. Apply talcum powder twice a day
Correct answer: B
Rationale: Nursing interventions should be grounded in a deep understanding of the physiological processes involved, ensuring that care provided is both effective and efficient.
3. After abdominal surgery, your patient has a severe coughing episode that causes wound evisceration. In addition to calling the doctor, which intervention is most appropriate?
- A. Irrigate the wound & organs with Betadine.
- B. Cover the wound with a saline soaked sterile dressing.
- C. Apply a dry sterile dressing & binder.
- D. Push the organs back & cover with moist sterile dressings.
Correct answer: B
Rationale: Covering the wound with a saline soaked sterile dressing is the most appropriate intervention for wound evisceration.
4. In an experiment, the independent variable __________.
- A. is the one the investigator expects to be influenced by another variable
- B. is the one the investigator expects to cause changes in another variable
- C. cannot be manipulated or controlled by the researcher
- D. is the number that describes how two measures are associated with each other
Correct answer: B
Rationale: In an experiment, the independent variable is the one that the investigator expects to cause changes in another variable. It is the factor that is deliberately manipulated or changed by the researcher to observe its effects on the dependent variable. The purpose of manipulating the independent variable is to study its impact on the outcome, allowing researchers to establish cause-and-effect relationships in their investigations. Choice A is incorrect because the independent variable is not influenced but rather influences another variable. Choice C is incorrect as the independent variable is intentionally manipulated by the researcher. Choice D is incorrect as it refers to a different concept unrelated to the independent variable in an experiment.
5. A nurse is teaching a newly licensed nurse about the stages of wound healing. The nurse should include in the teaching that collagen is added to the wound during which of the following stages?
- A. Hemostasis phase.
- B. Inflammatory phase.
- C. Proliferative phase.
- D. Maturation phase.
Correct answer: C
Rationale: The correct answer is C: Proliferative phase. During the proliferative phase of wound healing, collagen is added to the wound to promote tissue regeneration. In the hemostasis phase (choice A), the primary goal is to stop bleeding by forming a blood clot. The inflammatory phase (choice B) involves cleaning the wound and preparing it for healing. The maturation phase (choice D) is when the wound undergoes remodeling and gains strength, but collagen addition primarily occurs during the proliferative phase.
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