ATI RN
Nutrition ATI Test
1. All of the following are contraindications when giving Immunization except:
- A. BCG Vaccine can be given to a child with AIDS
- B. BCG Vaccine can be given to a child with Hepatitis B
- C. DPT can be given to a child that had convulsion 3 days after being given the first DPT dose
- D. DPT can be given to a child with active convulsion or other neurological disease
Correct answer: B
Rationale: The correct answer is B. BCG vaccine can be given to a child with Hepatitis B, as there is no contraindication for this. Choice A, C, and D all present contraindications for administering immunizations. Choice A is incorrect because giving BCG vaccines to a child with AIDS is a contraindication. Choice C is incorrect as convulsions after the first DPT dose indicate a contraindication to subsequent doses. Choice D is incorrect because active convulsions or other neurological diseases are contraindications to receiving the DPT vaccine.
2. A nurse is providing discharge teaching to a client following a heart transplant. Which of the following information should the nurse include in the teaching?
- A. Immunosuppressant medications need to be taken for up to 1 year
- B. Shortness of breath might be an indication of transplant rejection
- C. The surgical site will heal in 3 to 4 weeks after surgery
- D. Begin 45 minutes of moderate aerobic exercise per day following discharge
Correct answer: B
Rationale: The correct answer is B. Shortness of breath is an important sign of transplant rejection. Other manifestations of rejection include fatigue, edema, bradycardia, and hypotension. Choices A, C, and D are incorrect because: A) Immunosuppressant medications are typically required for life, not just up to 1 year. C) The surgical site healing time can vary and may take longer than 3 to 4 weeks. D) Starting a specific exercise regimen should be individualized and guided by healthcare providers; a general recommendation like 45 minutes of exercise per day may not be suitable for all heart transplant recipients.
3. A factor contributing to the risk for dehydration in the older adult is that _____.
- A. drinking fluids causes loss of bladder control
- B. older adults do not seem to notice mouth dryness as readily as younger people
- C. increased fluid intake will decrease the intake of nutrient-dense foods
- D. changes in intestinal motility contribute to excess fluid loss
Correct answer: C
Rationale: Older adults may not notice mouth dryness as readily as younger individuals, increasing their risk for dehydration, especially if they do not consciously increase fluid intake.
4. A nurse is reviewing the laboratory results of a client who is receiving warfarin therapy for atrial fibrillation. Which of the following laboratory values should the nurse report to the provider?
- A. INR 1.8
- B. Hemoglobin 14 g/dL
- C. Platelets 175,000/mm³
- D. Potassium 3.8 mEq/L
Correct answer: A
Rationale: The correct answer is A. An INR of 1.8 is below the therapeutic range for a client receiving warfarin, indicating a potential risk of blood clots. This value should be reported to the provider for further evaluation and possible adjustment of the warfarin dosage. Choices B, C, and D are within normal ranges and do not directly relate to the effectiveness or safety of warfarin therapy in this scenario, making them less urgent to report.
5. Which nursing diagnosis is a priority for clients with Borderline personality disorder?
- A. Risk for injury
- B. Ineffective individual coping
- C. Altered thought process
- D. Sensory perceptual alteration
Correct answer: C
Rationale: Effective nursing care involves comprehensive assessments that address all aspects of a patient's condition, ensuring that interventions are appropriately targeted and outcomes are optimized.