ATI RN
ATI Exit Exam
1. A client in active labor is being assessed by a nurse. Which of the following findings should the nurse report to the provider?
- A. Contractions lasting 80 seconds.
- B. FHR baseline of 170/min.
- C. Early decelerations in the FHR.
- D. Temperature of 37.4°C (99.3°F).
Correct answer: B
Rationale: The correct answer is B because a baseline FHR of 170/min indicates fetal tachycardia, which needs further evaluation. Choice A about contractions lasting 80 seconds is within the normal range for active labor. Choice C, early decelerations in the FHR, are generally considered benign and do not require immediate reporting. Choice D, a temperature of 37.4°C (99.3°F), falls within normal limits for a laboring client and does not warrant immediate reporting.
2. A nurse is reviewing the medical records of a client who has thrombocytopenia. Which of the following actions should the nurse include in the care plan?
- A. Encourage the client to floss daily.
- B. Remove fresh flowers from the client's room.
- C. Provide the client with a stool softener.
- D. Avoid serving raw vegetables.
Correct answer: C
Rationale: The correct answer is to provide the client with a stool softener. Thrombocytopenia is a condition characterized by a low platelet count, leading to decreased blood clotting ability. Providing a stool softener is essential to prevent constipation and straining during bowel movements, which can lead to bleeding in thrombocytopenic clients. Encouraging the client to floss daily (Choice A) is a good oral hygiene practice but is not directly related to managing thrombocytopenia. Removing fresh flowers from the client's room (Choice B) is important for immunocompromised clients to prevent exposure to pathogens but is not specifically related to thrombocytopenia. Avoiding serving raw vegetables (Choice D) is a precaution to reduce the risk of infection in immunocompromised clients but does not directly address the complications of thrombocytopenia.
3. A client is being taught about patient-controlled analgesia (PCA). Which statement should be included in the teaching?
- A. The PCA will deliver a double dose of medication when you push the button twice.
- B. Continuous PCA infusion is designed to allow fluctuating plasma medication levels.
- C. You should push the button before physical activity to allow maximum pain control.
- D. You can adjust the amount of pain medication you receive by pushing on the keypad.
Correct answer: D
Rationale: The correct statement to include in the teaching about PCA is that the client can adjust the amount of pain medication they receive by pushing on the keypad. This empowers the client to control their pain management effectively. Choice A is incorrect because PCA systems are programmed to prevent double dosing when the button is pressed multiple times in quick succession. Choice B is incorrect as continuous PCA infusion aims to maintain a steady plasma medication level. Choice C is incorrect because it is not necessary to push the button before physical activity to ensure maximum pain control; the client should use the PCA as needed for pain relief.
4. A client is receiving discharge instructions following a stroke. Which of the following client statements indicates an understanding of the teaching?
- A. I will avoid using aspirin for pain.
- B. I will consume dairy products to increase my calcium intake.
- C. I will drink 1.5 to 2 liters of fluid each day.
- D. I will need to limit my intake of fiber.
Correct answer: A
Rationale: The correct answer is A. Avoiding aspirin is crucial for this client as it can increase the risk of bleeding after a stroke. Choice B about consuming dairy products for calcium intake is not directly related to stroke management. Choice C regarding fluid intake is a good practice for overall health but not specifically related to stroke care. Choice D about limiting fiber intake is not typically a concern after a stroke unless there are specific complications that warrant it.
5. A healthcare provider is providing dietary teaching to a client who has a new diagnosis of irritable bowel syndrome (IBS). Which of the following foods should the healthcare provider instruct the client to avoid?
- A. Lean cuts of pork.
- B. Low-fat yogurt.
- C. White bread.
- D. Oatmeal.
Correct answer: D
Rationale: The correct answer is D, oatmeal. Oatmeal contains insoluble fiber, which can exacerbate the symptoms of irritable bowel syndrome. Choices A, B, and C are not typically problematic for individuals with IBS. Lean cuts of pork, low-fat yogurt, and white bread are generally well-tolerated and may even be recommended as part of a balanced diet for individuals with IBS.
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