ATI RN
ATI Exit Exam 2024
1. A nurse is providing teaching to family members of a client who has dementia. Which of the following instructions should the nurse include?
- A. Establish a toileting schedule for the client.
- B. Use clothing with buttons and zippers.
- C. Discourage physical activity during the day.
- D. Engage the client in activities that increase sensory stimulation.
Correct answer: A
Rationale: The correct answer is A: Establish a toileting schedule for the client. A toileting schedule helps manage incontinence and prevent accidents, promoting client dignity. Choice B is incorrect because clothing with buttons and zippers may be difficult for a client with dementia to manage independently. Choice C is incorrect as physical activity during the day is beneficial for clients with dementia. Choice D is incorrect as activities that increase sensory stimulation may be overwhelming for a client with dementia.
2. A nurse is caring for a client who has a prescription for spironolactone. Which of the following laboratory values should the nurse monitor?
- A. Sodium 140 mEq/L
- B. Calcium 9.5 mg/dL
- C. Potassium 5.2 mEq/L
- D. Magnesium 2.0 mEq/L
Correct answer: C
Rationale: The correct answer is C: Potassium 5.2 mEq/L. A potassium level of 5.2 mEq/L is elevated and should be monitored in clients taking spironolactone, which is a potassium-sparing medication. Monitoring potassium levels is crucial as spironolactone can cause hyperkalemia. Choices A, B, and D are incorrect because sodium, calcium, and magnesium levels are not typically affected by spironolactone. Therefore, the nurse should primarily focus on monitoring the potassium levels in this scenario.
3. A nurse is caring for a client who is in the orientation phase of the therapeutic relationship. Which statement should the nurse make during this phase?
- A. Let's talk about how you can change your response to stress.
- B. We should establish our roles in the initial session.
- C. Let me show you simple relaxation exercises to manage stress.
- D. We should discuss resources to implement in your daily life.
Correct answer: B
Rationale: During the orientation phase of the therapeutic relationship, it is crucial to establish roles. This helps both the client and the nurse understand their responsibilities, boundaries, and expectations within the therapeutic process. Choice A is more focused on the working phase where strategies and interventions are discussed. Choice C is more suitable for the working phase where specific techniques are usually introduced. Choice D is also more relevant to the working phase as it involves discussing practical resources for implementation in daily life.
4. A healthcare provider is reviewing the history of a client who is requesting combination oral contraceptives. Which condition in the client's history is a contraindication?
- A. Hyperthyroidism.
- B. Thrombophlebitis.
- C. Diverticulosis.
- D. Hypocalcemia.
Correct answer: B
Rationale: Thrombophlebitis is a contraindication for the use of combination oral contraceptives due to the increased risk of thromboembolic events such as deep vein thrombosis and pulmonary embolism. Hyperthyroidism, diverticulosis, and hypocalcemia are not typically contraindications for using combination oral contraceptives, making choices A, C, and D incorrect.
5. A client is receiving intermittent tube feedings and is at risk for aspiration. What should the nurse identify as a risk factor?
- A. A residual of 65mL 1 hour postprandial.
- B. History of gastroesophageal reflux disease.
- C. Receiving a high-osmolarity formula.
- D. Receiving a feeding in a supine position.
Correct answer: B
Rationale: The correct answer is B: History of gastroesophageal reflux disease. Gastroesophageal reflux disease increases the risk of aspiration due to the potential for regurgitation of stomach contents into the esophagus and airways. Choices A, C, and D are not directly related to an increased risk of aspiration. A residual of 65mL 1 hour postprandial may indicate delayed gastric emptying but is not a direct risk factor for aspiration. Receiving a high-osmolarity formula or receiving a feeding in a supine position are not specific risk factors for aspiration unless they contribute to reflux or other related issues.
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