ATI RN
ATI Exit Exam 2023
1. A nurse is assessing a client who is 1 hour postoperative following a hysterectomy. Which of the following findings should the nurse report to the provider?
- A. Heart rate of 78/min.
- B. Blood pressure of 120/80 mm Hg.
- C. Oxygen saturation of 94%.
- D. Respiratory rate of 16/min.
Correct answer: A
Rationale: A heart rate of 78/min is within the normal range; however, postoperative patients require close monitoring for any signs of complications. While the heart rate is normal, other critical findings such as increased pain, excessive bleeding, or other concerning symptoms may need immediate attention. Choices B, C, and D all indicate normal postoperative vital signs and oxygen saturation levels, which do not raise immediate concerns requiring reporting to the provider.
2. A client with a history of depression and experiencing a situational crisis is being assessed by a nurse. What action should the nurse take first?
- A. Notify the client's support system.
- B. Help the client identify personal strengths.
- C. Confirm the client's perception of the event.
- D. Teach the client relaxation techniques.
Correct answer: A
Rationale: When a client with a history of depression is experiencing a situational crisis, the first action the nurse should take is to notify the client's support system. This is crucial as the client may require immediate assistance and support. While helping the client identify personal strengths and confirming the client's perception of the event are important aspects of the assessment and intervention process, notifying the support system takes priority in ensuring the client's safety and well-being. Teaching relaxation techniques may be beneficial but addressing the client's immediate crisis through support system notification is the most appropriate initial action.
3. A nurse realizes that the wrong medication has been administered to a client. Which of the following actions should the nurse take first?
- A. Notify the provider
- B. Report the incident to the nurse manager
- C. Monitor vital signs
- D. Fill out an incident report
Correct answer: C
Rationale: The correct first action for the nurse to take after realizing that the wrong medication has been administered to a client is to monitor vital signs. Monitoring vital signs is crucial as it allows the nurse to promptly assess for any immediate adverse effects that may result from the wrong medication. This immediate assessment is essential for ensuring the client's safety and well-being. Notifying the provider (choice A) and reporting the incident to the nurse manager (choice B) are important steps to take, but they should come after ensuring the client's immediate safety. Filling out an incident report (choice D) is also necessary but should be done after addressing the client's immediate needs.
4. A nurse is caring for a client who has an indwelling urinary catheter. Which of the following interventions should the nurse implement to prevent catheter-associated infections?
- A. Change the catheter every 24 hours
- B. Ensure the drainage bag is positioned above the bladder
- C. Perform routine irrigation of the catheter
- D. Empty the drainage bag every 4 hours
Correct answer: B
Rationale: The correct answer is to ensure the drainage bag is positioned above the bladder. This positioning prevents urine reflux into the bladder, reducing the risk of catheter-associated infections. Changing the catheter too frequently (Choice A) can actually increase the risk of infection by introducing pathogens. Performing routine catheter irrigation (Choice C) is no longer recommended as it can increase the risk of infection by introducing bacteria. Emptying the drainage bag every 4 hours (Choice D) is a standard practice to prevent urinary stasis but is not directly related to preventing catheter-associated infections.
5. A healthcare professional is providing discharge teaching for a client with type 2 diabetes mellitus. Which resource should be provided?
- A. Personal blogs about managing the adverse effects of diabetes medications.
- B. Food label recommendations from the Institute of Medicine.
- C. Diabetes medication information from the Physicians' Desk Reference.
- D. Food exchange lists for meal planning from the American Diabetes Association.
Correct answer: D
Rationale: Food exchange lists from the American Diabetes Association are a valuable resource for meal planning in diabetes. These lists provide guidelines for portion control and help individuals make healthier food choices. Personal blogs may not always provide accurate and evidence-based information. Food label recommendations are important but may not specifically address meal planning for diabetes. Diabetes medication information is essential but not the primary focus when educating about dietary management for type 2 diabetes.
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