ATI RN
Multi Dimensional Care | Exam | Rasmusson
1. 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:
2. Dry skin (Xerosis) can lead to itching (Pruritis). What statement by the client indicates need for further teaching about preventing dry skin?
- A. I will drink at least 3000 mL of water daily."?
- B. . 'I will shower every day in hot water."?
- C. I will avoid tights belts."?
- D. I will use a humidifier during the winter months."?
Correct answer: B
Rationale:
3. What finding is often present in a client with osteoporosis?
- A. Chronic pain
- B. Dupuytren’s contracture
- C. Inflammation
- D. Kyphosis
Correct answer: D
Rationale: Kyphosis is a common finding in osteoporosis due to vertebral compression fractures. Chronic pain (Choice A) can occur in osteoporosis but is not a specific finding. Dupuytren’s contracture (Choice B) is a condition affecting hand fingers' connective tissue, not typically associated with osteoporosis. Inflammation (Choice C) is not a typical finding in osteoporosis but rather a characteristic of other conditions.
4. What is the nurse's priority action for a client with compromised immunity?
- A. Wash hands before entering the client's room
- B. Take the client's vital signs every 4 hours
- C. Determine whether it is temporary or permanent
- D. Teach the family members to receive the flu shot annually
Correct answer: A
Rationale:
5. What phase of wound healing occurs at the time of injury and lasts about 3-5 days?
- A. Maturation
- B. Intentional
- C. Inflammatory
- D. Proliferative
Correct answer: C
Rationale:
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