ATI RN
Multi Dimensional Care | Exam | Rasmusson
1. What nursing interventions increase the risk the pressure injuries?
- A. Padding hard surfaces
- B. Have client sit in wheelchair as much as possible
- C. Place pillows between bony surfaces
- D. Keep head of bed (HOB) at or less than 3
Correct answer: B
Rationale:
2. A client has cellulitis on his left arm. What statement by the client indicates understanding of symptom management?
- A. "I can use tight bandages on my arm."?
- B. "I should not apply heat to my arm."?
- C. "I can use a warm, moist towel on my arm."?
- D. "I should use a cold, dry source on my arm."?
Correct answer: C
Rationale:
3. What is a negative effect of immobility on the musculoskeletal system?
- A. Pressure injury
- B. Contractures
- C. Glucose intolerance
- D. Incontinence
Correct answer: B
Rationale: Contractures are a negative effect of immobility on the musculoskeletal system.
4. A nurse is caring for an immobile client. What is the priority assessment of this client?
- A. Palpate for edema
- B. Auscultate for bowel sounds
- C. Inspect the skin for injury
- D. Auscultation of lung sounds
Correct answer: C
Rationale: Inspecting the skin for injury is crucial to prevent pressure ulcers and other complications in immobile clients.
5. The nurse is providing education to a client regarding the administration of eye drops. Which of the following actions indicates the need for further client education?
- A. The client instills the prescribed number of eye drops into the conjunctival sac
- B. The client sets the cap to the eye drop container down in a manner that does not contaminate it
- C. The client touches the administration dropper her to the eye
- D. The client washes her hands before instilling the eye drops
Correct answer: C
Rationale:
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