the initial major sign of acute renal failure is
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Nursing Elites

ATI RN

ATI Nutrition Proctored Exam 2023 Test Bank

1. What is the initial major sign of acute renal failure?

Correct answer: A

Rationale: Oliguria, or reduced urine output, is often the initial major sign of acute renal failure. This reduction in urine output indicates that the kidneys are not functioning properly. Hematuria (blood in urine), proteinuria (presence of protein in urine), and glycosuria (presence of glucose in urine) are not typically the initial major signs of acute renal failure. While they may be present in certain conditions, oliguria is the most common and critical indicator of acute renal failure.

2. The nurse interprets the statement “Bow down before me! I am the holy mother of Christ! I am the blessed Virgin Mary!” as important in documenting in which of the following areas of mental status examination?

Correct answer: C

Rationale: Effective nursing care involves comprehensive assessments that address all aspects of a patient's condition, ensuring that interventions are appropriately targeted and outcomes are optimized.

3. Which change during pregnancy is related to the slowing of the gastrointestinal tract?

Correct answer: B

Rationale: During pregnancy, the gastrointestinal tract tends to slow down, leading to constipation. This is due to hormonal changes that relax the intestinal muscles, allowing more time for nutrient absorption and ultimately leading to constipation. Diarrhea is not typically associated with the slowing of the gastrointestinal tract during pregnancy. Decreased absorption of iron and calcium may occur during pregnancy due to increased demands, but they are not directly related to the slowing of the gastrointestinal tract.

4. What nutrition-related side effect is most likely to occur after head and neck surgery for cancer treatment?

Correct answer: A

Rationale: The most likely nutrition-related side effect after head and neck surgery for cancer treatment is aspiration. This is due to changes in swallowing mechanics, which can cause food or liquids to be inhaled into the lungs. While acid reflux, dumping syndrome, and diarrhea are potential side effects related to nutrition, they are not as directly connected to head and neck surgery. Acid reflux is more often related to issues with the lower esophageal sphincter, dumping syndrome is typically a complication of gastric surgery, and diarrhea can have various causes, including certain medications or gastrointestinal illnesses.

5. A nurse is planning care for a client who reports increasing difficulty swallowing food. Which of the following interventions should the nurse plan to take?

Correct answer: C

Rationale: The correct answer is to encourage the client to rest prior to mealtimes. This intervention can help reduce fatigue and improve the ability to swallow. Turning on the client’s television during meals (choice A) may distract the client but does not directly address the swallowing issue. Placing the client into a semi-reclining position for meals (choice B) can help with swallowing difficulties, but resting before meals is more beneficial. Encouraging the client to use a straw when drinking liquids (choice D) is not the priority intervention for swallowing difficulties in this scenario.

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