ATI RN
ATI RN Custom Exams Set 4
1. The nurse is preparing to assist in examining a Hispanic child who was brought to the clinic by the mother. During the assessment of the child, the nurse should take which action(s)?
- A. Admiring the child
- B. Taking the child’s temperature
- C. A, D
- D. Obtaining an interpreter if necessary
Correct answer: C
Rationale: In a multicultural healthcare setting, it's essential for the nurse to build rapport with the child and family. Admiring the child can help establish trust and comfort. Additionally, since the child's mother brought them to the clinic, it's crucial to ensure effective communication. Obtaining an interpreter, if necessary, is vital for clear and accurate information exchange. Taking the child's temperature, while important in a physical assessment, is not specifically highlighted in this scenario. Therefore, choices A and B alone are not sufficient, making the correct answer C, which includes both building rapport by admiring the child and ensuring clear communication by obtaining an interpreter if needed.
2. The client is diagnosed with hereditary spherocytosis. Which treatment/procedure would the nurse prepare the client to receive?
- A. Bone marrow transplant
- B. Splenectomy
- C. Frequent blood transfusions
- D. Liver biopsy
Correct answer: B
Rationale: The correct answer is B: Splenectomy. Splenectomy is the treatment of choice for hereditary spherocytosis. By removing the spleen, the excessive destruction of red blood cells is reduced, preventing hemolysis and improving anemia. Bone marrow transplant (A) is not a standard treatment for hereditary spherocytosis. Frequent blood transfusions (C) may temporarily address anemia but do not treat the underlying cause. Liver biopsy (D) is not indicated as a primary treatment for hereditary spherocytosis.
3. The two members of the health care team who work closely to monitor drug-nutrient interactions are:
- A. Physician and nurse
- B. Physician and pharmacist
- C. Nurse and clinical dietitian
- D. Clinical dietitian and pharmacist
Correct answer: D
Rationale: Clinical dietitians and pharmacists work together to manage drug-nutrient interactions. They have the expertise to understand how medications and nutrients can interact in the body, potentially affecting the effectiveness of treatment. Physicians and nurses may be involved in patient care, but when it comes to monitoring drug-nutrient interactions, the specialized knowledge of clinical dietitians and pharmacists is crucial. Nurses and physicians typically focus more on administering medications and managing overall patient care, rather than the specific interactions between drugs and nutrients.
4. The nurse is caring for a client who goes into ventricular tachycardia. Which intervention should the nurse implement first?
- A. Call a code immediately
- B. Assess the client for a pulse
- C. Begin chest compressions
- D. Continue to monitor the client
Correct answer: B
Rationale: The correct first intervention when a client goes into ventricular tachycardia is to assess for a pulse. This is crucial as the presence or absence of a pulse guides subsequent actions. Initiating chest compressions or calling a code should only be done after confirming the absence of a pulse. Continuing to monitor the client without checking for a pulse delays potentially life-saving interventions.
5. What is a primary intervention for managing hyperphosphatemia?
- A. Increasing calcium intake
- B. Increasing phosphorus intake
- C. Decreasing calcium intake
- D. Administering phosphate binders
Correct answer: D
Rationale: Administering phosphate binders is a primary intervention for managing hyperphosphatemia. Phosphate binders work by binding phosphorus in the gut, preventing its absorption. Increasing calcium intake (Choice A) is not a primary intervention for hyperphosphatemia and can actually exacerbate the condition by potentially raising calcium levels. Increasing phosphorus intake (Choice B) is contraindicated in hyperphosphatemia. Decreasing calcium intake (Choice C) may help manage hypercalcemia but is not the primary intervention for hyperphosphatemia.
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