ATI RN
ATI Exit Exam RN
1. A patient is diagnosed with deep vein thrombosis (DVT). Which of the following actions should the nurse take?
- A. Massage the affected extremity every 2 hours.
- B. Encourage the patient to ambulate as soon as possible.
- C. Apply warm compresses to the affected extremity.
- D. Elevate the affected extremity.
Correct answer: D
Rationale: Elevating the affected extremity is crucial in managing deep vein thrombosis (DVT) as it helps reduce swelling and promotes venous return, thereby preventing further complications such as pulmonary embolism. Massaging the affected extremity can dislodge a clot and lead to serious consequences. While ambulation is important, in DVT, early ambulation without elevation can potentially dislodge the clot. Warm compresses can increase blood flow to the area and worsen the condition by promoting clot dislodgement.
2. A healthcare provider is assessing a client who has COPD and is receiving oxygen therapy at 2 L/min via nasal cannula. Which of the following findings should the provider report?
- A. Oxygen saturation of 95%.
- B. Productive cough with clear sputum.
- C. Respiratory rate of 22/min.
- D. Client reports dyspnea.
Correct answer: D
Rationale: The correct answer is D. Dyspnea in a client with COPD receiving oxygen should be reported as it may indicate worsening respiratory status. Oxygen saturation of 95% is within the expected range for a client receiving oxygen therapy and does not require immediate reporting. A productive cough with clear sputum is a common symptom in clients with COPD and does not necessarily warrant urgent reporting. A respiratory rate of 22/min is also within normal limits and does not raise immediate concerns in this scenario.
3. During an in-service about nursing leadership, what information should the nurse include about an effective leader?
- A. Acts as an advocate for the nursing unit.
- B. Prioritizes staff requests over client needs.
- C. Shares personal opinions to influence the group's values.
- D. Provides routine client care and documentation.
Correct answer: A
Rationale: An effective leader advocates for the unit's success and its members. Choice B is incorrect because prioritizing staff requests over client needs does not align with effective leadership, which should focus on client-centered care. Choice C is incorrect as sharing personal opinions to influence the group's values can be biased and may not reflect the best interest of the team. Choice D is incorrect because while providing client care is essential, effective leadership involves more than routine tasks and includes guiding and supporting the team.
4. A nurse has just received change-of-shift report for four clients. Which of the following clients should the nurse assess first?
- A. A client who was just given a glass of orange juice for a low blood glucose level.
- B. A client who is scheduled for a procedure in 1 hr.
- C. A client who has 100 mL of fluid remaining in his IV bag.
- D. A client who received a pain medication 30 min ago for postoperative pain.
Correct answer: A
Rationale: A client with low blood glucose levels needs immediate assessment to ensure stabilization. Hypoglycemia can lead to serious complications if not addressed promptly. The other options do not present immediate life-threatening situations that require urgent assessment. Option B can be attended to after addressing the client with low blood glucose levels. Option C can be managed based on the infusion rate and the client's condition. Option D, although important, can be assessed after ensuring the client with low blood glucose levels is stable.
5. A client at risk for osteoporosis is being taught by a nurse about dietary measures to increase calcium intake. Which of the following foods should the nurse recommend?
- A. Carrots
- B. Cottage cheese
- C. Bananas
- D. Broccoli
Correct answer: D
Rationale: The correct answer is D: Broccoli. Broccoli is high in calcium, making it a suitable recommendation for clients at risk for osteoporosis. Carrots, Cottage cheese, and Bananas are not significant sources of calcium compared to broccoli, and therefore, they are not the best choices to increase calcium intake.
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