ATI RN
ATI Fluid Electrolyte and Acid-Base Regulation
1. A nurse assesses a client who is admitted with an acid-base imbalance. The clients arterial blood gas values are pH 7.32, PaO2 85 mm Hg, PaCO2 34 mm Hg, and HCO3 16 mEq/L. What action should the nurse take next?
- A. Assess clients rate, rhythm, and depth of respiration.
- B. Measure the clients pulse and blood pressure.
- C. Document the findings and continue to monitor.
- D. Notify the physician as soon as possible.
Correct answer: Assess clients rate, rhythm, and depth of respiration.
Rationale:
2. Legally, Patients chart are:
- A. Owned by the government since it is a legal document
- B. Owned by the doctor in charge and should be kept from the administrator for whatever reason
- C. Owned by the hospital and should not be given to anyone who request it other than the doctor in charge
- D. Owned by the patient and should be given by the nurse to the client as requested
Correct answer: C
Rationale: Effective nursing care involves comprehensive assessments that address all aspects of a patient's condition, ensuring that interventions are appropriately targeted and outcomes are optimized.
3. Which of the following grains is acceptable for someone with celiac disease?
- A. Rice
- B. Rye
- C. Wheat
- D. Barley
Correct answer: A
Rationale: The correct answer is A: Rice. Rice is a gluten-free grain, making it safe for individuals with celiac disease. Choices B, C, and D (Rye, Wheat, and Barley) contain gluten and are not suitable for individuals with celiac disease, as gluten can trigger adverse reactions in their bodies.
4. A healthcare professional is preparing to administer an intermittent enteral feeding to a client who has a nasogastric tube. Which of the following actions should the healthcare professional take first?
- A. Check the residual volume before administering the feeding
- B. Elevate the head of the bed to 30 degrees
- C. Flush the tube with 10 mL of sterile water
- D. Verify the client's tube placement
Correct answer: D
Rationale: Verifying the client's tube placement is the priority before administering any enteral feeding. This step ensures that the tube is correctly positioned in the stomach or intestines, minimizing the risk of complications such as aspiration. Checking the residual volume, elevating the head of the bed, and flushing the tube are important steps but should occur after confirming the tube placement to ensure the feeding is delivered safely and effectively.
5. Which nursing action will best help a patient with diabetes manage their condition?
- A. Monitor the patient's blood sugar levels regularly.
- B. Encourage the patient to follow a diabetic meal plan.
- C. Teach the patient how to administer insulin.
- D. Teach the patient about the complications of diabetes.
Correct answer: C
Rationale: The correct answer is C: Teach the patient how to administer insulin. This action is crucial in promoting self-management and control of diabetes. By educating the patient on administering insulin, they can actively participate in their treatment plan. Monitoring blood sugar levels (choice A) is important but doesn't empower the patient to take direct action. Encouraging a diabetic meal plan (choice B) is beneficial but may not directly address the need for insulin administration. Teaching about the complications of diabetes (choice D) is essential but may not be as immediately impactful as teaching insulin administration for day-to-day management.
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