ATI RN
ATI RN Exit Exam
1. A nurse is planning care for a client who had gastric bypass surgery 1 week ago and has signs of early dumping syndrome. Which of the following findings should the nurse expect?
- A. Facial flushing
- B. Syncope
- C. Diaphoresis
- D. Bradycardia
Correct answer: A
Rationale: Facial flushing is a common symptom of early dumping syndrome, which occurs when food moves too quickly into the small intestine. This rapid movement triggers the release of vasoactive peptides causing vasodilation, leading to facial flushing. Syncope (choice B) is not a typical finding in early dumping syndrome. Diaphoresis (choice C) and bradycardia (choice D) are also not characteristic symptoms of early dumping syndrome.
2. A client is receiving radiation therapy to the head and neck. Which of the following interventions should the nurse include?
- A. Instruct the client to use an alcohol-free mouthwash.
- B. Apply heat packs to the radiation site.
- C. Provide a diet low in carbohydrates.
- D. Avoid exposure to direct sunlight during treatment.
Correct answer: D
Rationale: The correct intervention for a client receiving radiation therapy to the head and neck is to avoid exposure to direct sunlight. Direct sunlight should be avoided to protect the skin from further irritation and damage caused by the radiation therapy. Instructing the client to use an alcohol-free mouthwash is important to prevent irritation and maintain oral hygiene, making choice A incorrect. Applying heat packs to the radiation site is contraindicated as heat can further aggravate the skin, making choice B incorrect. Providing a diet low in carbohydrates is not directly related to radiation therapy to the head and neck, so choice C is also incorrect.
3. A nurse is providing teaching to a client who has osteoporosis. Which of the following instructions should the nurse include?
- A. Take a calcium supplement once daily.
- B. Walk for 30 minutes three times per week.
- C. Avoid weight-bearing exercises.
- D. Increase intake of vitamin D.
Correct answer: B
Rationale: The correct answer is B. Walking regularly is beneficial for clients with osteoporosis as it helps maintain bone density and prevent fractures. Choice A is not the most appropriate because clients with osteoporosis often require more than just calcium supplements. Choice C is incorrect as weight-bearing exercises actually help strengthen bones. Choice D is important, but walking regularly has a more direct impact on bone health in clients with osteoporosis.
4. A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following laboratory values indicates the TPN is effective?
- A. Albumin 3.5 g/dL
- B. Hemoglobin 8 g/dL
- C. WBC count 15,000/mm3
- D. Blood glucose 110 mg/dL
Correct answer: D
Rationale: The correct answer is D. A blood glucose level of 110 mg/dL indicates that the TPN is effective in maintaining normal glucose levels. Hemoglobin level (choice B) is related to anemia and not directly indicative of TPN effectiveness. Albumin level (choice A) is a marker of nutritional status over a longer term and may not reflect immediate TPN effectiveness. White blood cell count (choice C) is related to infection or inflammation and is not a direct indicator of TPN effectiveness.
5. A client has a chest tube. Which of the following interventions should the nurse include?
- A. Clamp the chest tube for 15 minutes every 2 hours.
- B. Maintain the drainage system below the client's chest.
- C. Strip the chest tube every 2 hours.
- D. Keep the collection device at the level of the client's chest.
Correct answer: B
Rationale: Maintaining the chest tube drainage system below the client's chest level is crucial to ensure proper drainage and prevent complications. Clamping the chest tube can lead to a tension pneumothorax, stripping the chest tube is an outdated practice that can cause damage to the tissues, and keeping the collection device at the level of the client's chest can impede proper drainage and lead to fluid accumulation.
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