ATI RN
ATI Exit Exam 180 Questions Quizlet
1. A nurse is preparing to perform a sterile dressing change. Which of the following actions should the nurse take when setting up the sterile field?
- A. Place the cap from the solution sterile side up on a clean surface.
- B. Open the outermost flap of the sterile kit away from the body.
- C. Place the sterile dressing within 1.25 cm of the edge of the sterile field.
- D. Set up the sterile field 5 cm below waist level.
Correct answer: B
Rationale: When setting up a sterile field for a dressing change, the nurse should open the outermost flap of the sterile kit away from the body. This action helps maintain the sterility of the field by minimizing the risk of contamination. Option A is incorrect because the cap from the solution should be placed sterile side down to prevent contamination. Option C is incorrect because the sterile dressing should be placed at least 1.25 cm away from the edge of the sterile field to maintain its sterility. Option D is incorrect because the sterile field should be set up above waist level to prevent potential contamination from reaching the field.
2. 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.
3. When caring for a client with asthma experiencing an acute exacerbation, which medication should the nurse administer first?
- A. Montelukast
- B. Salmeterol
- C. Albuterol
- D. Fluticasone
Correct answer: C
Rationale: During an acute asthma exacerbation, the priority is to quickly relieve bronchoconstriction and improve airflow. Albuterol is a short-acting bronchodilator that acts rapidly to dilate the airways, making it the first-line medication for acute symptom relief. Montelukast is a leukotriene receptor antagonist used for long-term asthma control, not for immediate relief. Salmeterol is a long-acting bronchodilator used for maintenance therapy, not for acute exacerbations. Fluticasone is an inhaled corticosteroid that reduces airway inflammation and is also used for long-term control, not for immediate relief during an exacerbation.
4. A nurse is reviewing the laboratory results of a client who is at 28 weeks of gestation. Which of the following laboratory values should the nurse report to the provider?
- A. Hgb 10 g/dL
- B. Platelets 300,000/mm³
- C. WBC count 12,000/mm³
- D. BUN 18 mg/dL
Correct answer: A
Rationale: The correct answer is A: Hgb 10 g/dL. A hemoglobin level of 10 g/dL is below the normal range for a pregnant client, indicating possible anemia, which is crucial to report during pregnancy to prevent complications for both the mother and the baby. Platelets, WBC count, and BUN levels within the listed values are generally within normal ranges for a pregnant individual at 28 weeks of gestation. Platelets play a role in blood clotting, WBC count helps in fighting infections, and BUN measures kidney function, all of which are typically expected to be within normal limits during pregnancy.
5. A patient is scheduled to receive a transfusion of packed RBCs. Which of the following actions should the nurse take?
- A. Prime IV tubing with 0.9% sodium chloride
- B. Use a 24-gauge IV catheter
- C. Obtain filterless IV tubing
- D. Place blood in the warmer for 1 hour
Correct answer: A
Rationale: Priming the IV tubing with 0.9% sodium chloride is crucial before administering packed RBCs as it prevents hemolysis and ensures the safe transfusion of blood. Using a smaller 20- to 22-gauge IV catheter is recommended for packed RBCs to prevent hemolysis due to the small tubing size and faster flow rate. Obtaining filterless IV tubing is incorrect as blood products should be administered through a specialized filter to prevent potential clots or contaminants from reaching the patient. Placing blood in the warmer for an hour is unnecessary and could lead to overheating, potentially causing harm to the patient.
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