ATI RN
ATI RN Custom Exams Set 4
1. Which endocrine disorder would the nurse assess for in a client who has a closed head injury with increased intracranial pressure?
- A. Pheochromocytoma
- B. Diabetes insipidus
- C. Hashimoto’s disease
- D. Gynecomastia
Correct answer: B
Rationale: The correct answer is B, Diabetes insipidus. Diabetes insipidus can develop after a head injury due to damage to the hypothalamus or pituitary gland, leading to a deficiency in antidiuretic hormone (ADH). Pheochromocytoma (choice A) is a tumor of the adrenal gland and is not directly related to closed head injury or increased intracranial pressure. Hashimoto’s disease (choice C) is an autoimmune disorder affecting the thyroid gland, not commonly associated with head injuries. Gynecomastia (choice D) is the development of breast tissue in males and is not an endocrine disorder typically linked to closed head injuries.
2. A nurse is caring for a client with thrombocytopenia. Which action is the highest priority to reduce the risk of bleeding?
- A. Use an electric razor instead of a straight razor.
- B. Apply pressure to any bleeding sites for at least 5 minutes.
- C. Avoid invasive procedures unless absolutely necessary.
- D. Monitor for signs of internal bleeding.
Correct answer: C
Rationale: The highest priority action to reduce the risk of bleeding in a client with thrombocytopenia is to avoid invasive procedures unless absolutely necessary. Thrombocytopenia is a condition characterized by a low platelet count, which impairs the blood's ability to clot properly. By avoiding invasive procedures, the nurse minimizes the potential for bleeding episodes that could be challenging to control due to the low platelet count. Using an electric razor instead of a straight razor (Choice A) is a good practice to prevent cuts, but it is not as critical as avoiding invasive procedures in this scenario. Applying pressure to bleeding sites (Choice B) and monitoring for signs of internal bleeding (Choice D) are important interventions but are secondary to the priority of preventing bleeding by avoiding invasive procedures.
3. The unlicensed nursing assistant is applying elastic compression stockings to the client. Which action by the assistant warrants immediate intervention by the nurse?
- A. The assistant is putting the stockings on while the client is in the chair
- B. The assistant inserted two (2) fingers under the proximal end of the stocking
- C. The assistant elevated the feet while lying down to put on the stockings
- D. The assistant made sure the toes were warm after putting the stockings on
Correct answer: A
Rationale: The correct answer is A. Compression stockings should be applied while the client is lying down to prevent pooling of blood in the legs, which can occur when the client is sitting or standing. Choice B is incorrect as inserting two fingers under the proximal end of the stocking helps ensure proper fit. Choice C is incorrect as elevating the feet while lying down is a correct technique for applying compression stockings. Choice D is incorrect as ensuring the toes are warm after putting the stockings on is a good practice for client comfort.
4. For a patient diagnosed with borderline personality disorder exhibiting self-harming behavior, which therapeutic approach is most appropriate?
- A. Dialectical behavior therapy
- B. Psychoanalysis
- C. Supportive therapy
- D. Pharmacotherapy
Correct answer: A
Rationale: The most appropriate therapeutic approach for a patient diagnosed with borderline personality disorder exhibiting self-harming behavior is dialectical behavior therapy (DBT). DBT is specifically designed to address the core symptoms of borderline personality disorder, including self-harming behaviors. It focuses on teaching patients skills to manage emotions, improve interpersonal relationships, and enhance distress tolerance. Psychoanalysis (Choice B) is not the most appropriate for immediate symptom management in this case. Supportive therapy (Choice C) may not provide the structured approach needed to address self-harming behaviors effectively. Pharmacotherapy (Choice D) may be used as an adjunct in some cases, but DBT is the frontline therapy for managing self-harming behaviors in borderline personality disorder.
5. What is a critical element of program implementation in community health?
- A. Engaging community stakeholders
- B. Ensuring program sustainability
- C. Monitoring health outcomes
- D. Providing training for healthcare providers
Correct answer: A
Rationale: Engaging community stakeholders is a critical element of program implementation in community health because it ensures that the program is accepted and supported by the community. By involving stakeholders, the program can be tailored to meet the specific needs of the community, leading to better implementation and outcomes.