ATI RN
ATI Exit Exam 180 Questions Quizlet
1. A nurse is caring for a client who has Raynaud's disease. Which action should the nurse take?
- A. Provide information about stress management.
- B. Maintain a warm temperature in the client's room.
- C. Administer epinephrine for acute episodes.
- D. Give glucocorticoid steroids twice a day.
Correct answer: A
Rationale: The correct action for the nurse to take when caring for a client with Raynaud's disease is to provide information about stress management. Raynaud's disease is a condition where the blood vessels narrow in response to cold or stress, leading to reduced blood flow to certain areas of the body, usually the fingers and toes. Stress management helps reduce triggers for Raynaud's disease by minimizing emotional stress, which can trigger vasospasms. Choice B is incorrect as maintaining a warm temperature, rather than a cool one, is recommended for individuals with Raynaud's disease to prevent triggering vasospasms. Choice C is incorrect because epinephrine is not typically used to manage Raynaud's disease, as it can further constrict blood vessels. Choice D is incorrect as glucocorticoid steroids are not a first-line treatment for Raynaud's disease.
2. A nurse is providing discharge teaching to a client who is postoperative following a hip arthroplasty. Which of the following statements indicates a need for further teaching?
- A. I will avoid sitting in a recliner while recovering.
- B. I will bend at the waist to pick up items from the floor.
- C. I will use a pillow between my legs when lying on my side.
- D. I will avoid crossing my legs when sitting.
Correct answer: B
Rationale: The correct answer is B. Bending at the waist can increase the risk of dislocation following hip arthroplasty. This movement can put strain on the hip joint and potentially lead to complications. Choices A, C, and D are all correct statements that promote proper postoperative care and help prevent complications. Sitting in a recliner, using a pillow between the legs when lying on the side, and avoiding crossing legs when sitting are all appropriate instructions for a client recovering from hip arthroplasty.
3. A client has a central venous catheter. Which of the following actions should be taken to prevent an air embolism?
- A. Keep the catheter clamped when not in use
- B. Have the client perform the Valsalva maneuver while the catheter is removed
- C. Use a non-coring needle to access the catheter
- D. Flush the catheter with 0.9% sodium chloride every 24 hours
Correct answer: B
Rationale: The correct action to prevent an air embolism in a client with a central venous catheter is to have the client perform the Valsalva maneuver while the catheter is removed. This maneuver helps to close the airway and prevent air from entering the bloodstream. Keeping the catheter clamped at all times (Choice A) is not necessary and may lead to clot formation. Using a non-coring needle (Choice C) is important for accessing the catheter but does not specifically prevent air embolism. Flushing the catheter with 0.9% sodium chloride (Choice D) helps maintain patency but does not directly prevent air embolism.
4. A healthcare professional is reviewing the medical record of a client who has a new prescription for enoxaparin. Which of the following findings should the healthcare professional report to the provider?
- A. Platelet count 150,000/mm³
- B. aPTT 30 seconds
- C. Sodium 140 mEq/L
- D. Serum creatinine 3.0 mg/dL
Correct answer: D
Rationale: An elevated serum creatinine level indicates impaired kidney function, which can affect the metabolism and excretion of enoxaparin, potentially leading to increased drug levels and risk of bleeding. Therefore, it is crucial to report a high serum creatinine level before administering enoxaparin. Platelet count, aPTT, and sodium levels are not directly related to the administration of enoxaparin and would not impact its use; hence, they do not need to be reported before starting the medication.
5. A nurse is caring for a client who has Raynaud's disease. Which of the following actions should the nurse take?
- A. Provide information about stress management.
- B. Maintain a warm temperature in the client's room.
- C. Administer epinephrine for acute episodes.
- D. Give glucocorticoid steroids twice a day.
Correct answer: A
Rationale: Corrected Rationale: Providing information about stress management is essential when caring for a client with Raynaud's disease because stress can trigger episodes. Stress management techniques can help the client avoid triggers and reduce the frequency of episodes. Choice B is incorrect because maintaining a warm temperature, rather than a cool one, helps prevent vasoconstriction and can be beneficial for clients with Raynaud's disease. Choice C is incorrect because epinephrine is not a standard treatment for Raynaud's disease; it is more commonly used for severe allergic reactions. Choice D is incorrect because glucocorticoid steroids are not typically used in the management of Raynaud's disease.
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