ATI RN
ATI Nutrition Practice Test B 2019
1. The nurse knows that the most common complication of Measles is: A Pneumonia and larynigotracheitis
- A. Encephalitis
- B. Otitis Media
- C. Bronchiectasis
- D.
Correct answer: A
Rationale: Patient safety and efficacy of care depend on actions rooted in established nursing protocols that consider both the immediate and long-term needs of the patient.
2. What findings on physical assessment of a neonate would indicate the need for further evaluation?
- A. Nystagmus
- B. Epstein pearls
- C. Low-set ears
- D. Positive Babinski reflex
Correct answer: C
Rationale: Low-set ears in a neonate suggest major abnormalities and should prompt further evaluation. The correct alignment of the top of the pinnae of the ear with the outer canthus of the eye is crucial. Nystagmus, an involuntary eye movement, is common in newborns and often resolves on its own. Epstein pearls, small cysts on the hard palate, are insignificant and disappear over time. A positive Babinski reflex is normal in infants up to 1 year of age. Therefore, the presence of low-set ears is the most concerning finding that requires immediate attention.
3. A 58-year-old male patient has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray shows carcinoma. The patient is anxious and asks if he can smoke. Which statement by the nurse would be most therapeutic?
- A. Smoking is the reason you are here.
- B. The doctor left orders for you not to smoke.
- C. You are anxious about the surgery. Do you see smoking as helping?
- D. Smoking is OK right now, but after your surgery it is contraindicated.
Correct answer: C
Rationale: Choice C is the most therapeutic response as it acknowledges the patient's anxiety and encourages reflection on his behavior. This approach can help the patient explore his feelings and thoughts about smoking in relation to his surgery, promoting self-awareness and potentially opening the door for a constructive discussion. Choices A and B are more directive and may not address the underlying anxiety and need for reflection. Choice D is also somewhat permissive about smoking before surgery, which may not be in the patient's best interest.
4. In the treatment of a patient with obsessive-compulsive disorder (OCD) using cognitive-behavioral therapy (CBT), which specific type of CBT is most effective?
- A. Dialectical behavior therapy
- B. Exposure and response prevention
- C. Interpersonal therapy
- D. Supportive therapy
Correct answer: B
Rationale: Exposure and response prevention (ERP) is a specific type of CBT that is considered the most effective treatment for OCD. ERP involves exposing the individual to anxiety-provoking stimuli and preventing the usual compulsive responses, leading to a decreased anxiety response over time. This type of therapy helps individuals learn to tolerate the anxiety triggered by obsessions without engaging in compulsions, ultimately reducing OCD symptoms. Choices A, C, and D are incorrect. Dialectical behavior therapy (Choice A) is more commonly used for treating conditions like borderline personality disorder, not OCD. Interpersonal therapy (Choice C) focuses on improving interpersonal relationships and communication skills, which is not the primary approach for OCD. Supportive therapy (Choice D) provides emotional support and guidance but is not as effective as ERP in treating OCD.
5. A nurse is assessing a client who is receiving opioid analgesics for pain management. Which of the following findings should the nurse report to the provider?
- A. Respiratory rate of 20/min
- B. Blood pressure of 118/76 mm Hg
- C. Heart rate of 88/min
- D. Oxygen saturation of 94%
Correct answer: C
Rationale: The correct answer is C. A heart rate of 88/min is a normal finding; therefore, it does not require immediate reporting to the provider. The respiratory rate of 20/min, blood pressure of 118/76 mm Hg, and oxygen saturation of 94% are also within normal ranges and do not indicate any immediate concerns. However, a serum potassium level of 3.0 mEq/L indicates hypokalemia, which can be a serious issue and should be reported to the provider for further evaluation and management.