ATI RN
ATI Medical Surgical Proctored Exam
1. A patient is assessing a client who has just been admitted to the emergency department. The client is having difficulty breathing and is using accessory muscles. What action by the nurse is best?
- A. Administer oxygen at 2 liters per minute via nasal cannula.
- B. Assess the client's vital signs including oxygen saturation.
- C. Notify the Rapid Response Team immediately.
- D. Place the client in a high Fowler's position.
Correct answer: D
Rationale: Placing the client in a high Fowler's position is the best action in this situation as it helps to maximize lung expansion, improve breathing, and decrease the work of breathing. This position allows for better chest expansion, improving oxygenation and ventilation for the client in respiratory distress.
2. A nurse is providing discharge teaching to a client who has a new prescription for Warfarin. Which of the following statements should the nurse include?
- A. You should avoid taking aspirin for headaches while on this medication.
- B. You should use a soft toothbrush to brush your teeth.
- C. You should avoid foods that are rich in vitamin K.
- D. You should avoid prolonged exposure to sunlight.
Correct answer: B
Rationale: The correct statement to include in discharge teaching for a client prescribed Warfarin is to use a soft toothbrush to prevent gum bleeding. Warfarin is an anticoagulant that increases the risk of bleeding, so using a soft toothbrush can help prevent gum injury and bleeding. Choice A is incorrect because aspirin, another blood-thinning medication, should generally be avoided while on Warfarin to reduce the risk of bleeding. Choice C is incorrect because clients on Warfarin should maintain a consistent intake of vitamin K-rich foods rather than avoid them completely. Choice D is unrelated to the medication and not a priority teaching point for a client prescribed Warfarin.
3. A client with generalized anxiety disorder is prescribed buspirone (Buspar). Which statement by the client indicates an accurate understanding of the medication?
- A. I should take this medication as needed for anxiety.
- B. I need to avoid eating aged cheeses.
- C. It may take several weeks for this medication to take effect.
- D. I can stop taking this medication abruptly if I feel better.
Correct answer: C
Rationale: Buspirone (Buspar) may take several weeks to take effect, so clients should continue taking it as prescribed.
4. What should the nurse assess in a patient experiencing breakthrough bleeding while taking oral contraceptives?
- A. Adherence to the medication schedule
- B. The possibility of pregnancy
- C. The need for an increased dosage
- D. The effectiveness of the current oral contraceptive
Correct answer: A
Rationale: When a patient on oral contraceptives experiences breakthrough bleeding, the nurse should assess the patient's adherence to the medication schedule. Breakthrough bleeding is often a sign of non-adherence, potentially reducing the effectiveness of the contraceptives. Assessing the adherence to the schedule helps in determining if the medication is being taken correctly. The possibility of pregnancy (choice B) is less likely if the patient has been taking the contraceptives as prescribed. Increasing the dosage (choice C) without assessing adherence first can lead to unnecessary medication adjustments. Evaluating the effectiveness of the current oral contraceptive (choice D) comes after assessing adherence to the schedule.
5. Examples of patients suffering from impaired awareness include all of the following except:
- A. A semiconscious or overfatigued patient
- B. A disoriented or confused patient
- C. A patient who cannot care for themselves at home
- D. A patient demonstrating symptoms of drug or alcohol withdrawal
Correct answer: C
Rationale: Patients with impaired awareness may exhibit symptoms such as being semiconscious, overfatigued, disoriented, confused, or demonstrating symptoms of drug or alcohol withdrawal. A patient who cannot care for themselves at home does not necessarily indicate impaired awareness, as this could be due to physical limitations or lack of support, rather than a cognitive deficit.
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