ATI RN
ATI Exit Exam 2024
1. A nurse is caring for a client who requires seclusion to prevent harm to others on the unit. Which action should the nurse take?
- A. Offer fluids every 2 hours.
- B. Document the client's behavior prior to being placed in seclusion.
- C. Discuss with the client their inappropriate behavior prior to seclusion.
- D. Assess the client's behavior every hour.
Correct answer: B
Rationale: The correct answer is to document the client's behavior prior to seclusion. Documenting the behavior is crucial as it helps justify the need for seclusion, provides a clear record of events leading up to the intervention, and ensures transparency in the client's care. Offering fluids every 2 hours (Choice A) is important for hydration but is not directly related to the situation of seclusion. Discussing the inappropriate behavior with the client (Choice C) may not be safe or appropriate when seclusion is necessary for preventing harm. Assessing the client's behavior every hour (Choice D) is important but may not be the most immediate action needed when seclusion is already in place.
2. A nurse on a postsurgical unit is providing care for a 76-year-old female client who is two days post-hemiarthroplasty (hip replacement) and who states that her pain has been out of control for the last several hours, though she is not exhibiting signs of pain. Which guideline should the nurse use for short-term and long-term treatment of the client's pain?
- A. Pain is what the client says it is, even if she is not exhibiting outward signs.
- B. Pain should be treated only when it is associated with observable symptoms.
- C. Long-term opioid use is generally safe for elderly clients in a hospital setting.
- D. The client's pain should be reassessed after every dose of pain medication.
Correct answer: A
Rationale: Pain is a subjective experience, and the client's report of pain should be taken seriously even if there are no outward signs. Choice B is incorrect because pain can be present without observable symptoms, and waiting for observable signs may delay appropriate pain management. Choice C is incorrect because the safety of long-term opioid use in elderly clients is a complex issue and should be carefully evaluated due to the risk of adverse effects. Choice D is incorrect because while pain reassessment is important, it should not be limited to just after medication administration but should occur regularly to ensure adequate pain control.
3. In evaluating a client's response to stress, what would indicate a secondary appraisal of the stressful event?
- A. When the individual judges the event to be benign
- B. When the individual judges the event to be irrelevant
- C. When the individual judges the resources and skills needed to deal with the event
- D. When the individual judges the event to be pleasurable
Correct answer: C
Rationale: A secondary appraisal occurs when an individual evaluates the resources and skills required to cope with a stressful event. This type of appraisal focuses on the person's perceived ability to manage the situation. In contrast, choices A, B, and D do not involve the assessment of resources and skills. Choice A relates to a benign judgment of the event, choice B to an irrelevant judgment, and choice D to a pleasurable judgment, which are aspects of primary rather than secondary appraisals.
4. A client has a new prescription for Ranitidine. Which of the following instructions should the nurse include?
- A. Take the medication with an antacid.
- B. Avoid drinking coffee while taking this medication.
- C. Take the medication at bedtime.
- D. Stop the medication if you develop a headache.
Correct answer: C
Rationale: The correct instruction for a client prescribed Ranitidine is to take the medication at bedtime. Ranitidine is best taken at night to reduce nighttime stomach acid production, providing optimal relief for conditions like gastroesophageal reflux disease (GERD) and ulcers.
5. How should rifampin most likely be administered to a patient diagnosed with tuberculosis?
- A. Orally, with food
- B. Orally, on an empty stomach
- C. Intramuscularly
- D. Intravenously, as a bolus
Correct answer: A
Rationale: Rifampin is typically administered orally, and it is recommended to be taken with food to enhance its absorption and reduce gastrointestinal side effects. Administering rifampin intramuscularly or intravenously is not the standard route of administration for this medication used in tuberculosis treatment.
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