ATI RN
foundation of nursing practice questions Questions
Question 1 of 5
Which routine nursing assessment is contraindicated for a patient admitted with suspected placenta previa?
Correct Answer: A
Rationale: Vaginal examination of the cervix may result in perforation of the placenta and subsequent hemorrhage in a patient admitted with suspected placenta previa. It is important to avoid any unnecessary manipulation of the cervix to prevent complications. Assessing cervical dilation and effacement should be avoided until placenta previa is ruled out to prevent harm to the patient.
Question 2 of 5
A nurse is explaining to the nursing students working on the antepartum unit how to assess for edema. Which edema assessment score indicates edema of the lower extremities, face, hands, and sacral area? N R I G B.C M U S N T O
Correct Answer: C
Rationale: Edema of the extremities, face, and sacral area is classified as +3 edema. Edema classified as +1 indicates minimal edema of the lower extremities. Marked edema of the lower extremities is +2 edema. Generalized massive edema (+4) includes the accumulation of fluid in the peritoneal cavity.
Question 3 of 5
An uncircumcised 78-year-old male has presented at the clinic complaining that he cannot retract his foreskin over his glans. On examination, it is noted that the foreskin is very constricted. The nurse should recognize the presence of what health problem?
Correct Answer: C
Rationale: Phimosis is a condition in which the foreskin of the penis is tight and cannot be retracted over the glans. It can occur in uncircumcised males, like the 78-year-old male in this scenario. Phimosis may lead to difficulty with hygiene, pain during sexual activity, and an increased risk of infections. Treatment may involve conservative measures such as topical corticosteroids or, in severe cases, surgical intervention like circumcision to alleviate the tightness of the foreskin.
Question 4 of 5
A nurse is providing care for a patient who has recently been admitted to the postsurgical unit from PACU following a transuretheral resection of the prostate. The nurse is aware of the nursing diagnosis of Risk for Imbalanced Fluid Volume. In order to assess for this risk, the nurse should prioritize what action?
Correct Answer: A
Rationale: The nurse should prioritize closely monitoring the input and output of the bladder irrigation system to assess for the risk of imbalanced fluid volume in a patient following a transuretheral resection of the prostate. Bladder irrigation is a common postoperative procedure used to prevent blood clots and help with healing. Monitoring the input and output of the bladder irrigation system is crucial in assessing the patient's fluid balance. Changes in the output may indicate bleeding or retention, which can lead to imbalanced fluid volume. By closely monitoring the bladder irrigation system, the nurse can promptly identify any issues and intervene accordingly to prevent further complications. Monitoring the patient's level of consciousness, skin turgor, and scanning for bladder retention are important assessments, but for this specific situation, monitoring the bladder irrigation system is the priority to assess for imbalanced fluid volume.
Question 5 of 5
A nurse is caring for a patient hospitalized with AIDS. A friend comes to visit the patient and privately asks the nurse about the risk of contracting HIV when visiting the patient. What is the nurses best response?
Correct Answer: C
Rationale: The nurse's best response is option C - "AIDS isn't transmitted by casual contact." This response is accurate and provides the necessary information to address the friend's concern. It is important to educate the friend that HIV/AIDS is not transmitted through casual contact such as visiting a patient in the hospital. By stating this fact clearly, the nurse can help alleviate any unfounded fears or misconceptions the friend may have about contracting HIV while visiting the patient. This response promotes understanding and helps reduce stigma associated with HIV/AIDS, while also emphasizing the importance of accurate information in preventing the spread of the virus.
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