which assessment is not a nonverbal sing of pain
Logo

Nursing Elites

ATI RN

Multi Dimensional Care | Exam | Rasmusson

1. Which assessment is NOT a nonverbal sing of pain?

Correct answer: D

Rationale:

2. A client has a new arm cast. What is incorrect teaching by the nurse?

Correct answer: D

Rationale: Sudden increase in drainage is not expected and should be reported as it may indicate an infection or other complication.

3. What may be a cause of conductive hearing loss?

Correct answer: D

Rationale: Otitis media can cause conductive hearing loss by affecting the middle ear.

4. The nurse is teaching a client with debilitating rheumatoid arthritis about home safety. Which statement should the nurse include?

Correct answer: B

Rationale: The correct answer is B. This statement is the most appropriate because it focuses on providing practical solutions to enhance the client's safety at home while managing rheumatoid arthritis. Adaptive devices like grab bars, reaching tools, grasping devices, and adaptive silverware can help the client maintain independence and prevent accidents. Choice A is incorrect as it does not provide practical advice on home safety but rather a personal anecdote. Choice C is incorrect as throw rugs can pose a tripping hazard instead of enhancing safety. Choice D is also incorrect as it does not directly address home safety measures but rather shifts the focus to medication compliance.

5. What is correct about a nursing diagnosis?

Correct answer: A

Rationale: A nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems or life processes. Choice A is correct because it identifies nursing diagnosis as related to human responses to health conditions or life processes. Choice B is incorrect because nursing diagnoses can change as the patient's condition changes. Choice C is incorrect because a nursing diagnosis is about responses, not just identifying pathology. Choice D is incorrect because a nursing diagnosis is not the same as a disease, illness, or injury; it is a statement about the patient's response to these conditions.

Similar Questions

A client arrives speaking only Spanish. What is the priority nursing intervention?
The nurse is caring for a client who develops compartment syndrome from a severely fractured arm. The client asks how this can happen. What is the best response by the nurse?
A client with lupus experience Raynaud's phenomenon. What should the nurse include when providing client education about this?
The nurse is most concerned about which of these findings in a client with systemic lupus erythematous?
A nurse is teaching a newly hired group of unlicensed assistive personnel about infection-control measures on the unit. What is the most effective way to prevent the spread of pathogens during client care?

Access More Features

ATI RN Basic
$69.99/ 30 days

  • 5,000 Questions with answers
  • All ATI courses Coverage
  • 30 days access

ATI RN Premium
$149.99/ 90 days

  • 5,000 Questions with answers
  • All ATI courses Coverage
  • 30 days access

Other Courses