ATI RN
ATI Nutrition Practice Test A 2019
1. What is the purpose of a chest tube after a lobectomy procedure, as understood by the nurse?
- A. Prevent mediastinal shift
- B. Promote chest expansion of the remaining lung
- C. Drain fluids and blood accumulated post-operatively
- D. Remove the air in the lungs to promote lung expansion
Correct answer: C
Rationale: After a lobectomy, a chest tube is typically inserted to drain fluids and blood that may have accumulated post-operatively. This tube helps to prevent complications, such as infections or pneumonia, and aids in patient recovery. While a chest tube may aid in preventing a mediastinal shift (Choice A), promoting chest expansion of the remaining lung (Choice B), and removing air in the lungs to promote lung expansion (Choice D), these are not the primary reasons for its use after a lobectomy. Therefore, Choices A, B, and D are incorrect.
2. Prior to a thoracentesis, what intervention should the nurse complete?
- A. Measure oxygen saturation before and after the procedure.
- B. Verify that the client has given informed consent.
- C. Explain the procedure briefly to the client and their family.
- D. Ensure informed consent has been obtained from the client.
Correct answer: D
Rationale: Before a thoracentesis procedure, it is crucial to ensure that the client has given informed consent. This process involves explaining the procedure, its risks, benefits, and alternatives to the client, and obtaining their signature on the consent form. Verifying informed consent is a vital legal and ethical step to protect the client's autonomy and ensure they have made an informed decision about the procedure.
3. The following are appropriate nursing interventions during colostomy irrigation, EXCEPT:
- A. Increase the irrigating solution flow rate when abdominal cramps is felt
- B. Insert 2-4 inches of an adequately lubricated catheter to the stoma
- C. Position client in semi-Fowler
- D. Hang the solution 18 inches above the stoma
Correct answer: A
Rationale: Patient safety and efficacy of care depend on actions rooted in established nursing protocols that consider both the immediate and long-term needs of the patient.
4. A nurse in the medical-surgical unit has a newly admitted patient who is oliguric; the acute care nurse practitioner orders a fluid challenge of 100 to 200 mL of normal saline solution over 15 minutes. The nurse is aware this intervention will help:
- A. Distinguish hyponatremia from hypernatremia
- B. Evaluate pituitary gland function
- C. Distinguish reduced renal blood flow from decreased renal function
- D. Provide an effective treatment for hypertension-induced oliguria
Correct answer: C
Rationale: Administering a fluid challenge in oliguric patients helps to distinguish reduced renal blood flow from decreased renal function. This intervention aids in determining whether the oliguria is due to reduced renal blood flow (such as in fluid volume deficit or prerenal azotemia) or decreased renal function (such as in acute tubular necrosis). The response to this challenge can indicate the underlying cause. Choices A, B, and D are incorrect as they do not align with the purpose of a fluid challenge in oliguric patients.
5. A nurse is teaching a client about how to use her new hearing aids. Which of the following statements should the nurse identify as an indication that the client needs further instruction?
- A. I will not use hairspray if I am wearing the hearing aids
- B. I will clean the hearing aids with alcohol wipes
- C. I will change the batteries once a week
- D. I will expect the hearing aids to whistle when I cup my hand over them
Correct answer: B
Rationale: The correct answer is B because cleaning the hearing aids with alcohol wipes can damage them. It is important to use specialized cleaning tools or follow specific cleaning instructions provided by the manufacturer to prevent harm to the hearing aids. Choices A, C, and D demonstrate good understanding and appropriate care for hearing aids, indicating that the client does not need further instruction in those areas.