ATI RN
Multi Dimensional Care | Exam | Rasmusson
1. A wound has a blood-tinged liquid that is dripping from the surgical site. How does the nurse document this finding?
- A. Creamy pus
- B. Serous
- C. Serosanguineous
- D. Purulent exudate
Correct answer: C
Rationale:
2. The nurse is planning care for a post-operative client after a total hip arthroplasty. What is the priority nursing intervention?
- A. Observe client for changes in mental status
- B. Use aseptic technique for wound care and emptying of drains
- C. Keep the client's heels off the bed
- D. Perform neurovascular assessments per protocol
Correct answer: D
Rationale:
3. What should the nurse do first if they are stuck by a needle?
- A. Seek medical attention
- B. Flush the exposed skin with water
- C. Complete an incident report
- D. Report the exposure
Correct answer: B
Rationale:
4. A client with a bone cancer states that he is in too much pain to walk today. What should the nurse do first?
- A. Inquire about the frequency, quality and location of the pain
- B. Get the client pain medication
- C. Ensure the client knows he will have negative effects from immobility
- D. Review the client’s medication administration record
Correct answer: A
Rationale: Assessing the pain characteristics helps in managing the client’s pain effectively.
5. A client recently had an above the knee amputation and complains of pain distal to the amputation. What type of pain is the client experiencing?
- A. Nociceptive
- B. Neuropathic
- C. Visceral
- D. Cutaneous
Correct answer: A
Rationale:
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