ATI RN
ATI RN Comprehensive Exit Exam 2023
1. A nurse is caring for a client in labor who is receiving electronic fetal monitoring. The nurse notes early decelerations. Which of the following should the nurse expect?
- A. Fetal hypoxia
- B. Abruptio placentae
- C. Post maturity
- D. Head compression
Correct answer: D
Rationale: When a nurse notes early decelerations in electronic fetal monitoring, it indicates head compression, which is generally considered benign and not associated with fetal hypoxia, abruptio placentae, or post maturity. Early decelerations mirror the uterine contractions and are a normal response to fetal head compression during labor.
2. Which lab value is most critical to monitor in a patient receiving insulin therapy?
- A. Monitor blood glucose
- B. Monitor potassium levels
- C. Monitor calcium levels
- D. Monitor sodium levels
Correct answer: A
Rationale: The correct answer is to monitor blood glucose levels. When a patient is receiving insulin therapy, it is crucial to monitor blood glucose levels regularly to prevent hypoglycemia, a potential side effect of insulin therapy. Monitoring potassium, calcium, or sodium levels is important for different medical conditions or treatments and is not directly related to insulin therapy.
3. What is the best dietary recommendation for a patient with chronic liver disease?
- A. Low protein diet
- B. High protein diet
- C. Low sodium diet
- D. High sodium diet
Correct answer: A
Rationale: The best dietary recommendation for a patient with chronic liver disease is a low protein diet. In liver disease, the liver may have difficulty processing protein, leading to the accumulation of toxins like ammonia in the body. A low protein diet helps reduce the burden on the liver and minimizes the production of these harmful substances. High protein diets can exacerbate the condition by increasing the workload on the liver. A low sodium diet (Choice C) is also important for liver disease patients as excess sodium can contribute to fluid retention and swelling, but reducing protein intake is the primary focus in these cases.
4. A nurse is planning care for a client who has a new prescription for total parenteral nutrition (TPN). Which of the following interventions should the nurse include?
- A. Weigh the client weekly to monitor for fluid retention.
- B. Monitor the client's blood glucose level every 6 hours.
- C. Change the TPN tubing every 72 hours.
- D. Flush the TPN line with sterile water before and after administration.
Correct answer: B
Rationale: The correct answer is B: Monitor the client's blood glucose level every 6 hours. When a client is on TPN, it is crucial to monitor their blood glucose levels frequently to prevent complications such as hyperglycemia or hypoglycemia. Weighing the client weekly to monitor for fluid retention (choice A) is important but not as critical as monitoring blood glucose levels. Changing the TPN tubing every 72 hours (choice C) is important for infection control but does not directly relate to the client's metabolic status. Flushing the TPN line with sterile water before and after administration (choice D) is not a standard practice and may introduce contaminants into the TPN solution.
5. A client with gastroesophageal reflux disease (GERD) is being taught about lifestyle modifications. Which of the following instructions should be included?
- A. Sleep with the head of the bed elevated.
- B. Avoid drinking fluids with meals.
- C. Eat three large meals each day.
- D. Lie down after eating.
Correct answer: B
Rationale: The correct instruction for a client with GERD is to avoid drinking fluids with meals. This is because consuming fluids while eating can exacerbate reflux symptoms by increasing stomach distension and contributing to the reflux of stomach contents into the esophagus. Option A is incorrect as elevating the head of the bed can help prevent reflux during sleep, not while drinking fluids. Option C is incorrect as consuming three large meals a day can worsen GERD symptoms due to increased gastric distension. Option D is incorrect as lying down after eating can also worsen GERD symptoms by promoting the reflux of stomach contents into the esophagus.
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