ati health assessment test bank

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A nurse is caring for a patient with diabetes who is experiencing symptoms of diabetic neuropathy. The nurse should educate the patient to prioritize which of the following?

  • A. Inspecting feet daily for signs of injury.
  • B. Exercising to improve circulation.
  • C. Eating more protein-rich foods.
  • D. Using tight-fitting shoes to prevent blisters.
Correct Answer: A

Rationale: The correct answer is A: Inspecting feet daily for signs of injury. This is crucial for patients with diabetic neuropathy to prevent complications like foot ulcers. Daily foot inspections can catch any signs of injury early, allowing for prompt treatment. It helps in preventing infections and serious complications.

Summary of why other choices are incorrect:
B: Exercising to improve circulation - While exercise is beneficial for overall health, it may not directly address the risk of injury due to neuropathy.
C: Eating more protein-rich foods - While a balanced diet is important for managing diabetes, protein-rich foods do not specifically address the risk of foot injuries in diabetic neuropathy.
D: Using tight-fitting shoes to prevent blisters - Tight-fitting shoes can actually increase the risk of blisters and injuries, especially in patients with diabetic neuropathy.

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The nurse is assessing a patient's skin during an office visit. What is the best technique to use to best assess skin temperature?

  • A. Palpation
  • B. Auscultation
  • C. Inspection
  • D. Use of a thermometer
Correct Answer: A

Rationale: The correct answer is A: Palpation. Palpation involves using the hands to touch and feel the skin to assess its temperature accurately. This technique allows the nurse to detect variations in temperature more effectively compared to visual inspection (Choice C) or listening with a stethoscope (Choice B). Using a thermometer (Choice D) may also provide a precise measurement, but palpation allows for a more comprehensive assessment of skin temperature by considering factors such as localized warmth or coolness.

A nurse is teaching a patient with hypertension about lifestyle modifications. Which of the following dietary changes should the nurse emphasize?

  • A. Increase intake of foods high in sodium.
  • B. Decrease intake of saturated fats.
  • C. Increase intake of processed foods.
  • D. Decrease intake of fiber.
Correct Answer: B

Rationale: The correct answer is B: Decrease intake of saturated fats. Saturated fats can raise cholesterol levels, leading to increased risk of heart disease and hypertension. Decreasing intake of saturated fats can help lower blood pressure.

Incorrect choices:
A: Increasing intake of foods high in sodium can worsen hypertension by increasing blood pressure.
C: Increasing intake of processed foods often leads to higher sodium and saturated fat intake, worsening hypertension.
D: Decreasing intake of fiber is not ideal as fiber helps in maintaining a healthy weight and managing blood pressure.

A nurse is teaching a patient with a new diagnosis of diabetes about managing blood glucose levels. Which of the following statements by the patient indicates the need for further education?

  • A. I will monitor my blood glucose levels regularly.
  • B. I should follow a healthy diet to manage my condition.
  • C. I can stop taking my insulin when my blood sugar is normal.
  • D. I will exercise regularly to improve my health.
Correct Answer: C

Rationale: The correct answer is C: "I can stop taking my insulin when my blood sugar is normal." This statement indicates a misunderstanding of diabetes management. Here's the rationale:
1. Insulin is a crucial medication for managing diabetes, and stopping it abruptly can lead to serious complications.
2. Blood sugar levels can fluctuate, so stopping insulin when levels are normal is not safe or effective.
3. Proper education should emphasize the importance of consistent insulin use as prescribed by healthcare providers.
4. Choices A, B, and D demonstrate good understanding of diabetes management by focusing on monitoring blood glucose levels, following a healthy diet, and exercising regularly.

A nurse is caring for a patient who is post-operative following a knee replacement. Which of the following should the nurse prioritize in the post-operative care plan?

  • A. Pain management.
  • B. Encouraging early ambulation.
  • C. Administering IV antibiotics.
  • D. Monitoring for signs of deep vein thrombosis.
Correct Answer: B

Rationale: The correct answer is B: Encouraging early ambulation. Early ambulation helps prevent complications such as blood clots, improves circulation, aids in lung expansion, and promotes faster recovery. Pain management is important but encouraging mobility is a priority. Administering IV antibiotics is not necessary unless there is an infection present. Monitoring for signs of deep vein thrombosis is important but encouraging ambulation is a proactive approach to prevent its occurrence.

A nurse is caring for a patient with end-stage renal disease. The nurse should monitor the patient for which of the following?

  • A. Hypertension.
  • B. Hyperglycemia.
  • C. Hypothyroidism.
  • D. Hypokalemia.
Correct Answer: A

Rationale: The correct answer is A: Hypertension. In end-stage renal disease, the kidneys are no longer able to regulate blood pressure effectively, leading to hypertension. This can increase the risk of cardiovascular complications. Monitoring for hypertension is crucial in these patients.

Rationale for why the other choices are incorrect:
B: Hyperglycemia is more commonly associated with diabetes rather than end-stage renal disease.
C: Hypothyroidism is a separate condition not directly related to end-stage renal disease.
D: Hypokalemia may occur in some cases of renal disease, but hypertension is a more common and critical concern in end-stage renal disease.

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