ATI RN
ATI Nutrition
1. A client needs to increase his protein intake and enjoys certain foods. Which of the following foods should the nurse recommend as the best source of protein among these suggestions?
- A. Yams
- B. Eggs
- C. Chicken
- D. Peanuts
Correct answer: C: Chicken
Rationale: Chicken is the best source of protein among the options provided. It is a lean source of protein and contains essential amino acids needed for the body. Eggs are also a good source of protein, but chicken typically contains more protein per serving compared to eggs. Peanuts are a good source of plant-based protein, but chicken provides a higher amount of protein and is usually leaner. Yams, while nutritious, are not a significant source of protein compared to chicken, eggs, or peanuts.
2. A healthcare professional is planning to administer IV Alteplase to a client who is demonstrating manifestations of a massive Pulmonary Embolism. Which of the following interventions should the healthcare professional plan to take?
- A. Administer IM Enoxaparin along with the Alteplase dose.
- B. Hold direct pressure on puncture sites for up to 30 min.
- C. Administer Aminocaproic acid IV prior to alteplase infusion.
- D. Prepare to administer Alteplase within 8 hr of manifestation onset.
Correct answer: B
Rationale: The correct intervention when administering IV Alteplase is to hold direct pressure on puncture sites for 10 to 30 minutes or until oozing of blood stops. This helps prevent bleeding complications associated with thrombolytic therapy. Administering IM Enoxaparin is not indicated with Alteplase, as it is an anticoagulant rather than a thrombolytic agent. Aminocaproic acid is not typically administered prior to alteplase infusion in the context of a massive Pulmonary Embolism. While timely administration of Alteplase is important, the specific timeframe within which it should be administered may vary based on the clinical situation, so a strict 8-hour window is not universally applicable.
3. A nurse is caring for a client who has an indwelling urinary catheter. What should the nurse identify as a sign of catheter occlusion?
- A. Bladder spasms
- B. Bladder distention
- C. Frequent urination
- D. Hematuria
Correct answer: B
Rationale: The correct answer is B: Bladder distention. Bladder distention is a sign of catheter occlusion because it indicates a failure to drain urine properly. Bladder spasms (Choice A) are more commonly associated with bladder irritability rather than catheter occlusion. Frequent urination (Choice C) is unlikely in a client with an indwelling catheter as the urine should be draining continuously. Hematuria (Choice D) refers to blood in the urine and is not typically a direct sign of catheter occlusion.
4. A patient is considering options to manage his/her coronary artery disease. The nurse explains a coronary artery bypass graft procedure will:
- A. Cure the patient's coronary artery disease.
- B. Replace the leaking valve in the heart.
- C. Connect grafts to aorta to improve blood flow.
- D. Place a permanent pacemaker on the heart muscle.
Correct answer: C: Connect grafts to aorta to improve blood flow.
Rationale: The correct answer is C. A coronary artery bypass graft procedure involves connecting grafts to the aorta to improve blood flow to the heart muscle by bypassing blocked or narrowed coronary arteries. This procedure does not cure coronary artery disease but helps improve blood supply to the heart. Choices A, B, and D are incorrect because a bypass graft procedure does not cure the underlying disease, replace heart valves, or involve the placement of a pacemaker.
5. In cleaning the stoma, the nurse would use which of the following cleaning mediums?
- A. Hydrogen Peroxide, water and mild soap
- B. Providone Iodine, water and mild soap
- C. Alcohol, water and mild soap
- D. Mild soap and water
Correct answer: D
Rationale: Understanding the underlying pathology and therapeutic techniques ensures that nursing care is not only reactive but also preventative, reducing the risk of complications.
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