ATI RN
ATI Fundamentals
1. When assessing a client with sinusitis, which technique should the nurse use to identify manifestations of this disorder?
- A. Percussion of the frontal sinuses
- B. Auscultation of the trachea
- C. Inspection of the nasal mucosa
- D. Palpation of the orbital areas
Correct answer: D
Rationale: Sinusitis is an inflammation of the sinus cavities, which can cause tenderness and pain around the eyes (orbital areas). Palpation of the orbital areas can help identify tenderness and swelling associated with sinusitis. Auscultation of the trachea and percussion of the frontal sinuses are not relevant assessment techniques for sinusitis. Inspection of the nasal mucosa may reveal signs of inflammation, but palpation of the orbital areas is a more direct method to assess for tenderness and swelling in this specific condition.
2. A nurse manager is reviewing documentation with a newly licensed nurse. Which of the following notations by the newly licensed nurse indicates an understanding of the teaching?
- A. ''OOB with assistance for breakfast''
- B. ''Given 2 mg MSO4 IM for report of pain''
- C. ''Dressing changed qd''
- D. ''Administered 8 units of regular insulin subcutaneously''
Correct answer: D
Rationale: The correct answer demonstrates proper documentation by specifying the action taken ('Administered'), the dose ('8 units'), the medication ('regular insulin'), and the route of administration ('subcutaneously'). This notation ensures clarity and accuracy in recording the nursing intervention, aligning with best practices in documentation.
3. During physical therapy, a client with Parkinson's disease makes the following statements. Which statement indicates the need for a referral to physical therapy?
- A. ''I have been experiencing more tremors in my left arm than before''
- B. ''I noticed that I am having a harder time holding on to my toothbrush''
- C. ''Lately, I feel like my feet are freezing up, as they are stuck to the ground''
- D. ''Sometimes, I feel I am making a chewing motion when I'm not eating''
Correct answer: C
Rationale: Feeling like the feet are freezing up and sticking to the ground is a common symptom of Parkinson's disease known as 'freezing of gait.' This symptom significantly impacts mobility and can be dangerous, indicating the need for specialized physical therapy interventions to address gait disturbances and improve mobility.
4. A patient is admitted to the hospital with complaints of nausea, vomiting, diarrhea, and severe abdominal pain. Which of the following would immediately alert the healthcare provider that the patient has bleeding from the GI tract?
- A. Complete blood count
- B. Guaiac test
- C. Vital signs
- D. Abdominal girth
Correct answer: B
Rationale: A positive guaiac test is used to detect the presence of occult (hidden) blood in the stool, suggesting bleeding from the gastrointestinal tract. It is a rapid screening test that can provide immediate information to the healthcare provider about possible gastrointestinal bleeding in patients presenting with symptoms such as nausea, vomiting, diarrhea, and severe abdominal pain.
5. When assessing a client with a history of asthma, which of the following factors should the nurse identify as a risk for asthma?
- A. Gender
- B. Environmental allergies
- C. Alcohol
- D. None of the above
Correct answer: B
Rationale: When assessing a client with a history of asthma, the nurse should identify environmental allergies as a risk factor for asthma. Environmental allergens such as pollen, dust mites, mold, and pet dander can trigger asthma symptoms and exacerbate the condition. Gender, alcohol consumption, and other factors may not directly contribute to the development or exacerbation of asthma.
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