ATI RN
ATI RN Exit Exam 2023
1. A nurse is providing discharge teaching to a client who has hypertension about monitoring blood pressure at home. Which of the following instructions should the nurse include?
- A. Use a cuff that is too loose for the arm.
- B. Place the cuff over clothing.
- C. Sit quietly for 5 minutes before measuring your blood pressure.
- D. Use the same arm for each reading.
Correct answer: C
Rationale: The correct answer is to instruct the client to sit quietly for 5 minutes before measuring their blood pressure. This allows the body to relax and stabilize, leading to a more accurate reading. Choice A is incorrect because using a cuff that is too loose can result in inaccurate readings. Choice B is incorrect as the cuff should be placed directly on the bare skin. Choice D is incorrect as using the same arm for each reading is important for consistency in monitoring, but sitting quietly before measuring is crucial for accuracy.
2. A nurse is caring for a client who is experiencing dysphagia. Which of the following interventions should the nurse implement?
- A. Administer thickened liquids.
- B. Provide small bites of food.
- C. Encourage the client to eat quickly to avoid fatigue.
- D. Have the client lie supine after meals.
Correct answer: A
Rationale: The correct intervention for a client with dysphagia is to administer thickened liquids. Thickened liquids help prevent aspiration, which is a common risk for clients with swallowing difficulties. Providing small bites of food (choice B) can help, but the priority is to modify the liquid consistency. Encouraging the client to eat quickly (choice C) is not recommended as it may increase the risk of aspiration and fatigue. Having the client lie supine after meals (choice D) can actually increase the risk of aspiration, especially in clients with dysphagia.
3. Which electrolyte imbalance is most common in patients receiving furosemide?
- A. Hypokalemia
- B. Hypercalcemia
- C. Hyponatremia
- D. Hyperkalemia
Correct answer: A
Rationale: The correct answer is A, Hypokalemia. Furosemide, a loop diuretic, commonly leads to potassium loss in the urine, causing hypokalemia. This electrolyte imbalance should be closely monitored in patients taking furosemide. Choices B, C, and D are incorrect because hypercalcemia, hyponatremia, and hyperkalemia are not typically associated with furosemide use.
4. What is the priority intervention for a patient with a severe allergic reaction?
- A. Administer epinephrine
- B. Administer corticosteroids
- C. Administer oxygen
- D. Administer antihistamines
Correct answer: A
Rationale: The correct answer is to administer epinephrine. Epinephrine is the first-line treatment for severe allergic reactions because it rapidly reverses the symptoms of anaphylaxis by constricting blood vessels, increasing heart rate, and relaxing airway muscles. Corticosteroids, although helpful to reduce inflammation, are not the priority in the acute management of severe allergic reactions. Oxygen may be needed to support breathing, but it is not the initial priority. Antihistamines are not as effective as epinephrine in treating severe allergic reactions and should not be the first intervention.
5. How should signs of infection in a post-surgical patient be assessed?
- A. Check the surgical site
- B. Check the patient's vital signs
- C. Monitor for fever
- D. Check for abnormal breath sounds
Correct answer: A
Rationale: Assessing the surgical site is crucial in identifying early signs of infection post-surgery. Changes such as redness, swelling, warmth, or drainage may indicate an infection developing. While monitoring vital signs and fever are important in infection assessment, they are general indicators and may not show localized signs at the surgical site. Checking for abnormal breath sounds is more relevant when assessing respiratory issues rather than infection at the surgical site.
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