ATI RN
Multi Dimensional Care | Final Exam
1. While completing a health history the client reports experiencing blurring of vision in both eyes without associated pain. What condition does the nurse suspect?
- A. Macular degeneration
- B. Cataract
- C. Retinal detachment
- D. Glaucoma
Correct answer: B
Rationale: Cataracts can cause blurring of vision in both eyes without associated pain.
2. A nurse assesses an audible grating sound (Crepitus) when a client with osteoarthritis moves his knees. What is the cause of this sound?
- A. A herniated disk in the diseased joint
- B. Pieces of bone and cartilage floating
- C. Popping bursae from standing
- D. Years of an autoimmune process
Correct answer: A
Rationale:
3. A client is in skeletal traction. With the nurse's assessment, it is noted that the pairs appear red, swollen and there is purulent drainage. What action does the nurse take first?
- A. Collect a culture of the purulent fluid
- B. Cleanse the skin around the pins
- C. Administer an antibiotic
- D. Instruct the client to complete exercise of the affected extremity
Correct answer: A
Rationale:
4. A client with systemic sclerosis has been in bed for 2 weeks due to fatigue and abdominal pain. Today, the client came into the clinic complaining of her leg being hot, red and painful. What does the nurse suspect?
- A. Amputation
- B. Deep vein thrombosis
- C. Internal bleeding
- D. Kidney failure
Correct answer: B
Rationale:
5. A client is immobile and requires mechanical ventilation with a tracheostomy. She has a pressure injury on her coccyx measuring 5 cm by 3 cm. the nurse observes bone and tendon at the base of the wound. How would the nurse document this wound?
- A. Stage III pressure injury
- B. A stage II pressure injury
- C. A non-staging pressure injury
- D. Stage IV pressure injury
Correct answer: D
Rationale:
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