ATI RN
Multi Dimensional Care | Final Exam
1. What is the priority nursing diagnosis for a client with immobility?
- A. Constipation related to immobility
- B. Ineffective breathing pattern related to inability to breathe deeply in a supine position
- C. Risk for impaired skin integrity as evidenced by pressure over bony prominences
- D. Risk for disuse syndrome as evidenced by immobility
Correct answer: C
Rationale: The correct priority nursing diagnosis for a client with immobility is 'Risk for impaired skin integrity as evidenced by pressure over bony prominences.' Immobility predisposes the client to the development of pressure ulcers due to prolonged pressure on bony areas. Monitoring and preventing impaired skin integrity is crucial to prevent complications. Choices A, B, and D are not the priority in this case. Constipation, ineffective breathing pattern, and disuse syndrome are important but secondary to the immediate risk of skin breakdown associated with immobility.
2. The nurse is caring for a 65-year-old client and notes a temperature of 101�F. How does the nurse interpret this finding?
- A. Hyperthermia
- B. A cold environment
- C. Normal
- D. Hypothermia
Correct answer: A
Rationale: A temperature of 101�F is indicative of hyperthermia, which is an elevated body temperature. Hyperthermia is commonly associated with fever or environmental factors such as excessive heat exposure. Choice B, 'A cold environment,' is incorrect as hyperthermia refers to elevated body temperature, not a cold environment. Choice C, 'Normal,' is incorrect as a temperature of 101�F is above the normal range for body temperature. Choice D, 'Hypothermia,' is incorrect as hypothermia refers to a low body temperature, not an elevated one.
3. What should the nurse do first if they are stuck by a needle?
- A. Seek medical attention
- B. Flush the exposed skin with water
- C. Complete an incident report
- D. Report the exposure
Correct answer: B
Rationale:
4. The quality and risk nurse in the local hospital is performing a hospital survey on sentinel events. Which statements would the nurse use to best describe a sentinel event?
- A. Operating room event involving the use of unsafe equipments
- B. Specific events that enable a hospital to maximize reimbursement
- C. An unexpected event involving death or serious physical or psychological injury
- D. An event that can cause serious injury to a client that should never happen in a hospital
Correct answer: C
Rationale:
5. What are nonsurgical treatment options for carpal tunnel syndrome? (Select all that apply)
- A. Using a splint
- B. Ultrasound therapy
- C. Endoscopic carpal tunnel release
- D. All of the above
Correct answer: D
Rationale: The correct answer is D, 'All of the above.' Non-surgical treatments for carpal tunnel syndrome include using a splint, ultrasound therapy, corticosteroid injections, and NSAIDs. Choice A is correct as using a splint helps to keep the wrist in a neutral position, reducing pressure on the median nerve. Choice B is correct as ultrasound therapy can help reduce inflammation and alleviate symptoms. Choice C, 'Endoscopic carpal tunnel release,' is incorrect as it is a surgical procedure, not a nonsurgical treatment option for carpal tunnel syndrome.
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