ATI RN
ATI Fluid and Electrolytes
1. You are performing an admission assessment on an older adult patient newly admitted for end-stage liver disease. What principle should guide your assessment of the patient's skin turgor?
- A. Overhydration is common among healthy older adults.
- B. Dehydration causes the skin to appear spongy.
- C. Inelastic skin turgor is a normal part of aging.
- D. Skin turgor cannot be assessed in patients over 70.
Correct answer: C
Rationale: Inelastic skin is a normal change of aging. However, this does not mean that skin turgor cannot be assessed in older patients. Dehydration, not overhydration, causes inelastic skin with tenting. Overhydration, not dehydration, causes the skin to appear edematous and spongy. Choice A is incorrect because overhydration is not common among healthy older adults. Choice B is incorrect because dehydration leads to inelastic skin, not sponginess. Choice D is incorrect as skin turgor assessment can be done in patients of any age, including those over 70.
2. When teaching a client about a new prescription for Celecoxib, which of the following information should the nurse include?
- A. Increases the risk for a myocardial infarction
- B. Decreases the risk of stroke
- C. Inhibits COX-1
- D. Increases platelet aggregation
Correct answer: A
Rationale: The nurse should educate the client that taking Celecoxib increases the risk of a myocardial infarction due to its suppression of vasodilation. Celecoxib belongs to the class of NSAIDs known to have cardiovascular risks, including an increased risk of heart attacks. Choice B is incorrect because Celecoxib does not decrease the risk of stroke. Choice C is incorrect because Celecoxib selectively inhibits COX-2 rather than COX-1. Choice D is incorrect because Celecoxib does not increase platelet aggregation; in fact, it inhibits platelet aggregation.
3. A nurse is caring for a client who is 24 hours postpartum and is breastfeeding her newborn. The client asks the nurse to warm up seaweed soup that the client's partner brought for her. Which of the following responses should the nurse make?
- A. Does the doctor know you are eating that?
- B. Why are you eating seaweed soup?
- C. Of course I will heat that up for you.
- D. The hospital food is more nutritious.
Correct answer: C
Rationale: Agreeing to heat up the seaweed soup respects the client's cultural preferences and promotes a positive postpartum experience. Seaweed soup is a traditional food in some cultures, often believed to support recovery and breastfeeding. The nurse's supportive response fosters cultural sensitivity, which is crucial in providing patient-centered care.
4. During the 2-month well-child checkup, the nurse expects the infant to respond to sound in which manner?
- A. Respond to name
- B. React to loud noise with Moro reflex
- C. Turn his or her head to side when sound is at ear level
- D. Locate sound by turning his or her head in a curving arc
Correct answer: B
Rationale: At 2 months, infants typically react to loud noises with the Moro reflex, a startle response that is normal at this stage of development.
5. What is a major barrier to accessing health care services?
- A. Cultural differences
- B. High cost of services
- C. Lack of transportation
- D. Long wait times
Correct answer: B
Rationale: The high cost of services can be a significant barrier that prevents individuals from accessing necessary health care. Financial constraints can deter people from seeking medical help, leading to negative health outcomes.
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