ATI RN
Multi Dimensional Care | Exam | Rasmusson
1. 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:
2. 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:
3. A nurse is caring for an immobile client. What is the priority assessment in this client?
- A. Auscultation of lung sounds
- B. Assessment of skin turgor
- C. Auscultation of bowel sounds
- D. Assessment for the presence of peripheral edema
Correct answer: A
Rationale:
4. A client does not understand why vision loss due to glaucoma is irreversible. What is the nurse's best explanation?
- A. Once retinal detachment occurs, it does not return to its normal state
- B. Once the tissue has necrosed from high-pressure, it does not regenerate
- C. Glaucoma always leads to permanent blindness
- D. Once bacterial infection has caused damage, the tissue does not regenerate
Correct answer: B
Rationale: The correct explanation for irreversible vision loss in glaucoma is that once the tissue has necrosed from high pressure, it does not regenerate. This necrosis occurs due to the damage caused by increased intraocular pressure, which leads to irreversible damage to the optic nerve and retinal tissue. Choices A, C, and D are incorrect because they do not directly address the specific mechanism of irreversible vision loss in glaucoma, which is necrosis due to high pressure.
5. The client states, “the doctor says I am nearsighted. I do not get it.†What would be the best response by the nurse?
- A. I am sorry you did not understand. Would you like a different doctor?
- B. Nearsighted, or myopia means that you have difficulty seeing things at a distance.
- C. You will need to have glasses.
- D. This means you won’t ever need glasses.
Correct answer: B
Rationale: The correct response is to explain to the client what nearsightedness means, which is having difficulty seeing distant objects, as known as myopia. Choice A is not helpful as changing doctors is not necessary for this situation. Choice C is premature as wearing glasses is a possible solution but not the only one. Choice D is incorrect as nearsightedness (myopia) often requires glasses for correction.
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