ATI RN
Multi Dimensional Care | Exam | Rasmusson
1. The client had surgery one day ago. What assessment is most likely related to pain?
- A. Blood pressure of 175/90 mm Hg
- B. Respirations of 10 breaths per minute
- C. Heart rate 60 beats/minute
- D. Oxygen saturation of 97%
Correct answer: A
Rationale:
2. What evaluation indicates successful progress on the client goal of increasing daily physical activity?
- A. The client reports decreased social interaction
- B. The client reports more nonsteroidal anti-inflammatory drug (NSAID) use
- C. The client reports a fall
- D. The client reports less fatigue walking up stairs
Correct answer: D
Rationale: The correct answer is D because reporting less fatigue when walking up stairs indicates improved physical endurance, showing progress in increasing daily activity. Choices A, B, and C are incorrect because decreased social interaction, increased NSAID use, and experiencing a fall are not indicators of successful progress in increasing daily physical activity.
3. A client is post-operative day 1 and reports a sudden increase in blood-tinged liquid draining from his incision after feeling a popping sensation. What is the nurse's next action?
- A. Send the client back to surgery
- B. Assess the wound for signs of dehiscence
- C. Call the provider immediately
- D. Prepare to culture the wound
Correct answer: B
Rationale:
4. A nurse assesses an audible grating sound (Crepitus) when a client with osteoarthritis moves his knees. What is the cause of this sound?
- A. A herniated disk in the diseased joint
- B. Pieces of bone and cartilage floating
- C. Popping bursae from standing
- D. Years of an autoimmune process
Correct answer: A
Rationale:
5. What is a negative effect of immobility on the musculoskeletal system?
- A. Pressure injury
- B. Contractures
- C. Glucose intolerance
- D. Incontinence
Correct answer: B
Rationale: Contractures are a negative effect of immobility on the musculoskeletal system.
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