ATI RN
Multi Dimensional Care | Exam | Rasmusson
1. A client who is sitting in High-Fowler's position is at risk for what type of injury as the skin layers shift in opposite directions?
- A. Traumatic injury
- B. Pressure injury
- C. Friction injury
- D. Shearing injury
Correct answer: D
Rationale:
2. Which among the following is NOT the cause of pressure ulcers?
- A. Immobility
- B. Poor nutrition
- C. Moisture
- D. Adequate perfusion
Correct answer: D
Rationale:
3. Which of the following lab tests should NOT be used for diagnosing connective tissue diseases?
- A. Rheumatoid factor (RF)
- B. Erythrocyte sedimentation rate (ESR)
- C. Anti-nuclear antibody (ANA)
- D. Thyroid stimulating hormone (TSH)
Correct answer: D
Rationale:
4. Why is traction used?
- A. It allows the bones to realign
- B. It decreases the risk of misalignment
- C. It promotes wound healing
- D. It allows the client to rest longer
Correct answer: A
Rationale: Traction is used to help align the bones properly during the healing process. Choice A is correct because traction assists in allowing the bones to realign correctly, promoting proper healing. Choice B is incorrect as traction does not decrease the risk of misalignment; instead, it helps reduce misalignment by aiding in bone alignment. Choice C is incorrect because while traction indirectly supports wound healing by ensuring proper bone alignment, its primary purpose is not wound healing. Choice D is incorrect as the primary purpose of traction is not to allow the client to rest longer, but rather to aid in bone alignment for optimal healing.
5. The nurse is assessing a client who had a cast placed 4 hours ago. What assessment finding is cause for concern?
- A. The nurse assesses capillary refill of 2 seconds
- B. The nurse cannot insert one finger between the cast and the skin
- C. The nurse finds 2+ pulses distal from the cast
- D. The nurse does not observe any drainage
Correct answer: B
Rationale: Inability to insert a finger between the cast and skin indicates the cast is too tight, risking circulation problems.
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