ATI RN
ATI Comprehensive Exit Exam 2023
1. A nurse is preparing to administer an IV medication to a client who has an allergy to latex. Which of the following actions should the nurse take?
- A. Use latex gloves when administering the medication.
- B. Use latex-free syringes when administering the medication.
- C. Administer the medication through a latex-free IV port.
- D. Administer the medication with a latex-free syringe.
Correct answer: C
Rationale: The correct action for the nurse to take when preparing to administer IV medication to a client with a latex allergy is to administer the medication through a latex-free IV port. This is crucial as it prevents direct contact of the medication with latex, reducing the risk of an allergic reaction. Choice A is incorrect as using latex gloves can still expose the client to latex. Choice B is not the best option since the administration route is not specified, and using a latex-free syringe alone may not be sufficient to prevent exposure. Choice D is not the most appropriate because the IV tubing and ports should also be latex-free to ensure complete avoidance of latex contact.
2. A nurse is caring for a client who is receiving radiation therapy for breast cancer. Which of the following skin care instructions should the nurse provide?
- A. Wear loose clothing over the radiation site.
- B. Use scented lotions to moisturize the skin.
- C. Apply ice packs to the radiation site for pain relief.
- D. Expose the radiation site to sunlight for 20 minutes daily.
Correct answer: A
Rationale: The correct answer is A: Wear loose clothing over the radiation site. Clients receiving radiation therapy should wear loose clothing over the treatment area to prevent irritation and promote healing. Choice B is incorrect as scented lotions can irritate the skin during radiation therapy. Choice C is incorrect because ice packs should not be applied to the radiation site as they can exacerbate skin reactions. Choice D is incorrect as exposing the radiation site to sunlight can increase skin damage and should be avoided.
3. A nurse is assessing a client who is receiving morphine via a patient-controlled analgesia (PCA) pump. Which of the following findings should the nurse report to the provider?
- A. Respiratory rate of 20/min
- B. Oxygen saturation of 93%
- C. Pain level of 2 on a scale of 0 to 10
- D. Blood pressure of 110/70 mm Hg
Correct answer: D
Rationale: The correct answer is D because a blood pressure drop or other signs of morphine overdose should be reported, especially when using a PCA pump. Choices A, B, and C are within normal limits and do not indicate an immediate concern related to morphine administration.
4. A nurse is assessing a client who is receiving opioid analgesics for pain management. Which of the following findings should the nurse report to the provider?
- A. Respiratory rate of 20/min
- B. Blood pressure of 118/76 mm Hg
- C. Heart rate of 88/min
- D. Oxygen saturation of 94%
Correct answer: C
Rationale: The correct answer is C. A heart rate of 88/min is a normal finding; therefore, it does not require immediate reporting to the provider. The respiratory rate of 20/min, blood pressure of 118/76 mm Hg, and oxygen saturation of 94% are also within normal ranges and do not indicate any immediate concerns. However, a serum potassium level of 3.0 mEq/L indicates hypokalemia, which can be a serious issue and should be reported to the provider for further evaluation and management.
5. A charge nurse on a medical-surgical unit is planning assignments for a licensed practical nurse (LPN) who has been sent from the unit due to a staffing shortage. Which of the following clients should the nurse delegate to the LPN?
- A. A client who has an Hgb of 6.3 g/dl and a prescription for packed RBCs.
- B. A client who sustained a concussion and has unequal pupils.
- C. A client who is postoperative following a bowel resection with an NG tube.
- D. A client who fractured his femur yesterday and is experiencing shortness of breath.
Correct answer: C
Rationale: The correct answer is C because a client who is postoperative following a bowel resection with an NG tube can be delegated to an LPN as this involves routine postoperative care. Option A involves administering packed RBCs which requires assessment and monitoring for potential adverse reactions, not suitable for delegation to an LPN. Option B requires neurological assessment and close monitoring due to the concussion, which is beyond the scope of an LPN. Option D involves a client with a recent fracture and shortness of breath, which requires urgent assessment and intervention beyond the LPN's scope of practice.
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