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ATI Fundamentals
1. When planning care for a client on mechanical ventilation, which mode of ventilation that increases the effort of the client's respiratory muscles should NOT be included in the plan of care?
- A. Assist-control
- B. Synchronized intermittent mandatory ventilation
- C. Continuous positive airway pressure
- D. Pressure support ventilation
Correct answer: A
Rationale: Assist-control ventilation mode delivers a preset tidal volume at a set rate; however, it may not be suitable for clients who need to maintain some level of respiratory muscle activity. This mode provides full support for each breath, potentially leading to decreased respiratory muscle strength over time. Therefore, it is important to avoid using assist-control mode for clients who require increased effort of respiratory muscles to prevent muscle atrophy and promote optimal respiratory function.
2. Which term is best described as a systematic, rational method of planning and providing nursing care for individuals, families, groups, and communities?
- A. Assessment
- B. Nursing Process
- C. Diagnosis
- D. Implementation
Correct answer: B
Rationale: The correct answer is B: Nursing Process. The nursing process is a systematic, rational method that guides nurses in planning and delivering patient care. It involves a series of steps including assessment, diagnosis, planning, implementation, and evaluation. By utilizing the nursing process, nurses can provide individualized care tailored to the specific needs of patients, families, groups, and communities. Choice A, Assessment, is a step within the nursing process but does not encompass the entire process itself. Choice C, Diagnosis, is another step within the nursing process and focuses on identifying the patient's health problems. Choice D, Implementation, is also a step in the nursing process where the care plan is put into action, but it does not solely describe the entire systematic and rational method of planning and providing nursing care.
3. If a patient's blood pressure is 150/96, what is his pulse pressure?
- A. 54
- B. 96
- C. 150
- D. 246
Correct answer: A
Rationale: Pulse pressure is calculated by subtracting the diastolic pressure from the systolic pressure. In this case, the systolic pressure is 150 and the diastolic pressure is 96. Therefore, the pulse pressure is 150 - 96 = 54. Pulse pressure represents the force generated by the heart with each contraction and is an important indicator of cardiovascular health.
4. A healthcare professional is assessing a client who has experienced a left-hemispheric stroke. Which of the following is an expected finding?
- A. Impulse control difficulty
- B. Poor judgement
- C. Inability to recognize familiar objects
- D. Loss of depth perception
Correct answer: C
Rationale: Patients who have experienced a left-hemispheric stroke may exhibit symptoms of agnosia, which is the inability to recognize familiar objects or people. This occurs due to damage to the right hemisphere of the brain, which is responsible for visual and spatial perception. Impulse control difficulty, poor judgment, and loss of depth perception are not typically associated with left-hemispheric strokes.
5. During a seizure, what is the primary intervention?
- A. Protect the patient from injury
- B. Insert an airway
- C. Elevate the head of the bed
- D. Withdraw all pain medications
Correct answer: A
Rationale: The primary intervention during a seizure is to protect the patient from injury. This involves creating a safe environment by moving harmful objects away, cushioning the head, and staying with the patient until the seizure ends. Inserting an airway is only necessary if the patient's airway is obstructed, not routinely during a seizure. Elevating the head of the bed is not a priority during an active seizure as it won't affect the seizure's outcome. Withdrawing all pain medications is not a standard practice unless there are specific contraindications related to the seizure itself.
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