ATI RN
Multi Dimensional Care | Exam | Rasmusson
1. Which of the following would be the most appropriate goal for an elderly client with a nursing diagnosis of risk for injury after hip surgery?
- A. Client will increase mobility by the time of discharge from hospital
- B. Client will demonstrate effective breathing pattern when ambulating throughout hospital stay
- C. Client will increase activity tolerance by discharge from the hospital
- D. Client will remain free from falls throughout their hospital stay
Correct answer: D
Rationale:
2. The nurse is caring for 4 clients. Which of these clients will the nurse see first?
- A. A client with rheumatoid arthritis and a scheduled pain medication
- B. A client being discharged in 2 hours and needs to be taught how to use crutches
- C. A client with sudden and increasing pain in a fractured arm
- D. A client with a fractured ankle who would like a glass of water
Correct answer: C
Rationale: The correct answer is C because sudden and increasing pain in a fractured arm indicates a potential complication that requires immediate attention to assess and manage. Choices A, B, and D do not present immediate life-threatening situations or emergent needs compared to sudden and increasing pain in a fractured arm, which takes priority to ensure the client's safety and comfort.
3. A nurse is assessing a client with hallux valgus. What is another term for this assessment finding?
- A. Thoracic deformity
- B. A bunion
- C. A corn
- D. Metacarpal involvement
Correct answer: B
Rationale: Hallux valgus is commonly known as a bunion, which is a bony bump that forms on the joint at the base of the big toe. A) Thoracic deformity is unrelated to hallux valgus. C) A corn is a thickened area of skin on the foot, not synonymous with hallux valgus. D) Metacarpal involvement refers to the hand, not the foot where hallux valgus occurs.
4. Which of the following statements made by a client diagnosed with human immunodefiency virus (HIV) would require further teaching?
- A. "I will have to be careful and avoid crowds."?
- B. "I will take prescribed medications."?
- C. "I will have to take medications for the rest of my life."?
- D. "I will only need to take HIV medications for 6 months, and I will be cured
Correct answer: D
Rationale:
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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