ATI RN
Multi Dimensional Care | Exam | Rasmusson
1. The nurse is teaching a client with debilitating rheumatoid arthritis about home safety. Which statement should the nurse include?
- A. "My grandfather always had problems with his arthritis, and he would tell me that it is better to be more stoic and not let pain interrupt your life"?
- B. "There are many adaptive devices such as grab bars, reaching tools, grasping devices, and adaptive silverware available that may help you."?
- C. "Place throw rugs throughout your home. You will enjoy how pretty they are, and you can use them to cover up power cords, so you do not trip on them."?
- D. "Lack of home safety may be an issue of compliance. Are you being compliant with your medication?"?
Correct answer: B
Rationale: The correct answer is B. This statement is the most appropriate because it focuses on providing practical solutions to enhance the client's safety at home while managing rheumatoid arthritis. Adaptive devices like grab bars, reaching tools, grasping devices, and adaptive silverware can help the client maintain independence and prevent accidents. Choice A is incorrect as it does not provide practical advice on home safety but rather a personal anecdote. Choice C is incorrect as throw rugs can pose a tripping hazard instead of enhancing safety. Choice D is also incorrect as it does not directly address home safety measures but rather shifts the focus to medication compliance.
2. A client has sustained an open fracture. What nursing intervention will best prevent osteomyelitis in this client?
- A. Delegate all client personal care to specific unlicensed assistive personnel
- B. Place the client in contact precautions
- C. Proper hand hygiene
- D. Administer pain medication
Correct answer: C
Rationale: Proper hand hygiene is crucial in preventing infections such as osteomyelitis in clients with open fractures. Keeping the hands clean helps reduce the risk of introducing harmful pathogens to the wound site. Delegating all client personal care to specific unlicensed assistive personnel (Choice A) is not appropriate as direct involvement in wound care is essential in preventing infections. Placing the client in contact precautions (Choice B) is not directly related to preventing osteomyelitis in this context. Administering pain medication (Choice D) is important for managing the client's pain but does not directly address the prevention of osteomyelitis.
3. What is one of the earliest signs of fat embolism syndrome?
- A. Paresthesia
- B. Severe pain in the affected limb unrelieved by medication
- C. Edema
- D. Hypoxemia
Correct answer: D
Rationale: Hypoxemia is one of the earliest signs of fat embolism syndrome. In fat embolism syndrome, fat globules enter the bloodstream and can obstruct blood flow in the lungs, leading to hypoxemia. Paresthesia, severe pain unrelieved by medication, and edema are not typically among the earliest signs of fat embolism syndrome.
4. While completing a health history the client reports experiencing blurring of vision in both eyes without associated pain. What condition does the nurse suspect?
- A. Macular degeneration
- B. Cataract
- C. Retinal detachment
- D. Glaucoma
Correct answer: B
Rationale: Cataracts can cause blurring of vision in both eyes without associated pain.
5. A nurse is teaching a newly hired group of unlicensed assistive personnel about infection-control measures on the unit. What is the most effective way to prevent the spread of pathogens during client care?
- A. Properly dispose of contaminated equipment
- B. Perform hand hygiene
- C. Discard used syringes into appropriate containers
- D. Change soiled linens
Correct answer: B
Rationale:
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