ATI RN
Multi Dimensional Care | Exam | Rasmusson
1. Which assessment is NOT a nonverbal sing of pain?
- A. Decreased attention span
- B. Grimacing
- C. Increase in heart rate
- D. Reported pain of 5/10
Correct answer: D
Rationale:
2. Which of the following statements by a client with human immunodeficiency virus (HIV) does NOT requires further teaching?
- A. I can spread this through contact with surfaces, so I need to wear gloves in public.'
- B. Because I have HIV, that means I'm an AIDS patient'
- C. I need to ensure that I place my needles in a proper needle disposal container.'
- D. I can still have unprotected intercourse with my partner since he does not have HIV.'
Correct answer: C
Rationale:
3. A client is experiencing numbness and tingling distal to a new arm cast with no increase in pain. The nurse assesses that the client's fingers are pale, cool and swollen. What action does the nurse take next?
- A. Remove the cast to decrease pressure
- B. Raise the arm above the level of the heart
- C. Apply heat to the affected hand
- D. Encourage range of motion
Correct answer: B
Rationale:
4. A nurse is caring for an intubated and sedated geriatric client. What intervention is most appropriate for reducing the risk for a friction and shear injury?
- A. Use a mechanical lift to reposition the client every 2 hours
- B. Elevate the client's head of the bed to 45 degrees
- C. Postpone daily bed bath
- D. Caregiver independently slides the client up in the bed
Correct answer: A
Rationale:
5. What is the term for a ringing in the ears reported by the client?
- A. Weber
- B. Rinne
- C. Pinna
- D. Tinnitus
Correct answer: D
Rationale: Tinnitus is the correct answer. Tinnitus refers to the perception of noise or ringing in the ears. This condition can be constant or intermittent and may be caused by various factors such as exposure to loud noises, ear infections, or underlying health conditions. Choices A, B, and C are incorrect as Weber and Rinne tests are related to hearing assessment, while the pinna is the external part of the ear responsible for collecting sound waves.
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