ATI RN
ATI Exit Exam RN
1. How should a healthcare professional monitor for infection in a patient with a central line?
- A. Check the central line dressing daily
- B. Monitor for signs of redness
- C. Check for abnormal breath sounds
- D. Monitor temperature
Correct answer: A
Rationale: Correct answer: A. Checking the central line dressing daily is crucial to monitor for signs of infection around the insertion site. This practice helps in early detection of any changes such as redness, swelling, or discharge, which are indicators of a potential infection. Monitoring for signs of redness (choice B) is limited as redness alone may not always indicate an infection; other symptoms like discharge and tenderness should also be observed. Checking for abnormal breath sounds (choice C) is not directly related to monitoring central line infections. Monitoring temperature (choice D) is important for detecting systemic signs of infection but may not specifically indicate an infection related to the central line site.
2. A client expresses fear of surgery. Which response should the nurse make?
- A. Explain the risks of the surgery in detail.
- B. Tell the client that many clients feel anxious before surgery.
- C. Reassure the client that the surgical team is highly experienced.
- D. Acknowledge the client's feelings and ask open-ended questions.
Correct answer: D
Rationale: When a client expresses fear of surgery, it is essential for the nurse to acknowledge their feelings and ask open-ended questions. This response shows empathy, validates the client's emotions, and encourages them to express their concerns further. Explaining the risks of the surgery in detail (Choice A) may increase the client's anxiety. Simply stating that many clients feel anxious before surgery (Choice B) does not address the client's specific fears. While reassuring the client about the surgical team's experience (Choice C) is important, it may not directly alleviate the client's fear.
3. While caring for a client with an arterial line, which of the following actions should the nurse take?
- A. Level the transducer with the client's phlebotomy site
- B. Flush the arterial line every 8 hours
- C. Obtain a blood sample for arterial blood gases
- D. Keep the client's hand elevated above the heart level
Correct answer: C
Rationale: Obtaining arterial blood gases is a crucial nursing action when caring for a client with an arterial line. This procedure helps assess the client's oxygenation status and acid-base balance accurately. Leveling the transducer with the client's phlebotomy site (A) is important for accurate pressure measurements, but it is not the primary action in this scenario. Flushing the arterial line every 8 hours (B) is a routine maintenance procedure and not the immediate priority. Keeping the client's hand elevated above the heart level (D) is a good practice to prevent swelling, but it is not directly related to the arterial line care in this case.
4. A nurse is providing teaching to a client who has a new prescription for levothyroxine. Which of the following instructions should the nurse include?
- A. Take this medication on an empty stomach.
- B. Take this medication at bedtime.
- C. Take this medication with food.
- D. Take this medication with a calcium supplement.
Correct answer: A
Rationale: The correct answer is A: 'Take this medication on an empty stomach.' Levothyroxine should be taken on an empty stomach to enhance absorption. Taking it with food or at bedtime can interfere with its absorption. Calcium supplements should also be avoided when taking levothyroxine as they can reduce its absorption.
5. What is the priority intervention for a patient presenting with chest pain?
- A. Administer aspirin
- B. Administer nitroglycerin
- C. Reposition the patient
- D. Prepare for surgery
Correct answer: A
Rationale: The correct answer is to administer aspirin. Administering aspirin is a priority intervention for a patient presenting with chest pain because it helps reduce the risk of further clot formation and improves oxygenation. Aspirin is commonly used in the initial management of suspected cardiac chest pain. Administering nitroglycerin can follow aspirin administration to help with vasodilation. Repositioning the patient or preparing for surgery are not the primary interventions for chest pain presentation.
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