ATI RN
Multi Dimensional Care | Final Exam
1. What should be done immediately after an ankle injury?
- A. Immobilize, heat, compress, and elevate the ankle
- B. Rest, ice, compress, and lower the ankle
- C. Rest, ice, compress, and elevate the ankle
- D. Rest, incubate, confine, and lower the ankle
Correct answer: C
Rationale: The correct answer is C: Rest, ice, compress, and elevate the ankle. After an ankle injury, it is essential to follow the RICE method (Rest, Ice, Compression, Elevation) for immediate treatment. Resting the injured ankle helps prevent further damage, applying ice reduces swelling and pain, compression with a bandage provides support and helps control swelling, and elevating the ankle above heart level reduces swelling by allowing fluid to drain away from the injury site. Choices A, B, and D are incorrect because heating, incubating, or confining the ankle can worsen the injury by increasing swelling and inflammation instead of reducing them.
2. A client is in the emergency room in critical condition and hypotensive. Her spouse is distraught. What is the priority nursing action?
- A. Maintain the client's blood pressure
- B. Call a chaplain
- C. Provide the spouse a chair
- D. Ask the client's spouse to explain what happened
Correct answer: A
Rationale:
3. A post-operative client with a sutured abdominal incision felt a sharp abdominal pain after having a bowel movement. Upon inspection, the nurse notices bowel protruding from the incision site. What does the nurse tell the physician about the event?
- A. The client's incision site has eviscerated
- B. The client's incision site has lacerated
- C. The client's incisional site is approximated
- D. The client's incisional site has dehisced after.
Correct answer: A
Rationale:
4. Which practice is recommended to prevent human immune deficiency virus (HIV) transmission by health care workers?
- A. Wearing a mask within three feet of the client
- B. Using standard precautions
- C. Applying hand sanitizer to gloves during cares
- D. Double gloving
Correct answer: B
Rationale:
5. A nurse assesses an area of skin over a bony prominence. What finding would be most concerning?
- A. Redness
- B. Non-blanching
- C. Blanching
- D. Warmth
Correct answer: A
Rationale:
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