ATI RN
ATI Exit Exam
1. A nurse is assessing a client who is in active labor. Which of the following findings should the nurse report to the provider?
- A. Contractions lasting 80 seconds.
- B. FHR baseline 170/min.
- C. Early decelerations in the FHR.
- D. Temperature 37.4°C (99.3°F).
Correct answer: B
Rationale: The correct answer is B. An FHR baseline of 170/min is considered tachycardia, which is above the normal range during labor and requires immediate attention. High FHR can indicate fetal distress or maternal fever. Choice A, contractions lasting 80 seconds, are within normal range for active labor. Choice C, early decelerations in the FHR, are usually benign and do not typically require immediate intervention. Choice D, a temperature of 37.4°C (99.3°F), is within normal limits.
2. A client who is intubated and has an intra-aortic balloon pump is restless and agitated. What action should the nurse perform first for comfort?
- A. Allow family members to remain at the bedside.
- B. Ask the family if the client would like a fan in the room.
- C. Keep the television tuned to the client's favorite channel.
- D. Speak loudly to the client in case of hearing problems.
Correct answer: A
Rationale: Allowing the family to remain at the bedside can help calm the client with familiar voices and presence, potentially reducing restlessness and agitation. Introducing a fan may not be the priority as it can spread germs through air movement. Keeping the television on all the time may not promote rest and recovery. Speaking loudly is not advisable as it may further agitate the client. Therefore, the initial action of allowing family members to stay is most likely to provide comfort and reassurance to the client.
3. When is the time to make people think about the routines that have been previously followed and to consider what might be a better plan of action?
- A. Collection of data
- B. Planning
- C. Analyzing data
- D. Identification
Correct answer: B
Rationale: The correct answer is B, 'Planning.' Planning is the phase where individuals reflect on current routines and explore alternative courses of action. This stage involves considering new strategies and approaches, making it the most suitable time to challenge existing norms. Choice A, 'Collection of data,' focuses on gathering information rather than actively reconsidering routines. Choice C, 'Analyzing data,' involves assessing the gathered data rather than proposing new plans. Choice D, 'Identification,' does not specifically address the process of reviewing routines and suggesting improvements, making it less relevant to the question.
4. While out for a walk, you come across a ferocious dog. You feel your heart beating faster and your palms begin to sweat. Which part of the peripheral nervous system is activated in this situation?
- A. Autonomic
- B. Sympathetic
- C. Parasympathetic
- D. Somatic
Correct answer: B
Rationale: The correct answer is B: Sympathetic. When encountering a stressful situation like a ferocious dog, the sympathetic nervous system is activated, leading to the 'fight or flight' response. This response triggers physiological changes like increased heart rate, sweating, and heightened alertness to prepare the body to deal with the perceived threat. The autonomic nervous system (Choice A) encompasses both the sympathetic and parasympathetic divisions, so it's a broader category. The parasympathetic nervous system (Choice C) is responsible for the body's 'rest and digest' functions, which are opposite to the physiological changes seen in a stress response. The somatic nervous system (Choice D) controls voluntary movements and sensory information, not the physiological responses seen in a stress reaction.
5. In children with Type 1 diabetes, what is a common early sign of hypoglycemia?
- A. Irritability
- B. Rapid heartbeat
- C. Confusion
- D. Sweating
Correct answer: D
Rationale: Sweating is indeed one of the earliest signs of hypoglycemia in children with Type 1 diabetes. When blood sugar levels drop too low, the body releases stress hormones like adrenaline, which can lead to sweating. While irritability, rapid heartbeat, and confusion can also be seen in hypoglycemia, sweating is particularly common as a quick indicator of low blood sugar levels in children with Type 1 diabetes.
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