ATI RN
ATI RN Custom Exams Set 3
1. The nurse supervises care of a client who is receiving enteral feeding via a nasogastric tube. The nurse determines that care is appropriate if which of the following is observed? (Select all that apply)
- A. The nursing assistant aspirates and measures the amount of the gastric aspirate
- B. The nursing assistant elevates the head of the client’s bed 30 degrees
- C. The nursing assistant warms the formula to room temperature
- D. B, C
Correct answer: D
Rationale: Elevating the head of the bed to 30 degrees reduces the risk of aspiration by promoting proper digestion and preventing reflux. Warming the formula to room temperature is essential to prevent discomfort and complications. Aspirating and measuring the gastric aspirate is not a recommended nursing action for monitoring enteral feeding via a nasogastric tube, as it can introduce the risk of introducing contaminants into the feeding tube. Therefore, choices A and B are incorrect, making choice D the correct answer.
2. The client is diagnosed with hereditary spherocytosis. Which treatment/procedure would the nurse prepare the client to receive?
- A. Bone marrow transplant
- B. Splenectomy
- C. Frequent blood transfusions
- D. Liver biopsy
Correct answer: B
Rationale: The correct answer is B: Splenectomy. Splenectomy is the treatment of choice for hereditary spherocytosis as it helps prevent hemolysis and improve anemia. Removing the spleen reduces the destruction of the abnormal red blood cells. Choice A, Bone marrow transplant, is not a standard treatment for hereditary spherocytosis. Choice C, Frequent blood transfusions, may be used to manage anemia in some cases but is not the primary treatment for hereditary spherocytosis. Choice D, Liver biopsy, is not a treatment for hereditary spherocytosis; it is a procedure used to diagnose liver conditions, not related to this hematologic disorder.
3. Management experience prepares the practical nurse to be a Clinical NCO or a Senior Clinical NCO. These positions are normally held by which of the following?
- A. Army Nurse Corps officer
- B. First Sergeant
- C. E6, E7, or E8
- D. E3, E4, or E5
Correct answer: C
Rationale: Corrected Rationale: Clinical NCO or Senior Clinical NCO positions are typically held by personnel ranked E6, E7, or E8 in the military structure. These individuals have the necessary experience and leadership skills to fulfill the responsibilities associated with these roles. Choices A, B, and D are incorrect because these positions are not specifically designated for Army Nurse Corps officers, First Sergeants, E3, E4, or E5 personnel in the military hierarchy.
4. The nurse is teaching the client with peripheral vascular disease. Which intervention should the nurse discuss with the client?
- A. Keep the area between the toes dry.
- B. Wear comfortable, well-fitting shoes.
- C. Cut toenails straight across.
- D. A,B
Correct answer: D
Rationale: The correct interventions for a client with peripheral vascular disease include keeping the area between the toes dry to prevent moisture-related skin issues and wearing comfortable, well-fitting shoes to prevent injury and promote circulation. Cutting toenails straight across is important to prevent ingrown toenails, but in this case, an arch cut can lead to injury. Therefore, choices A and B are correct, making option D the most appropriate answer. Choice C is incorrect in this context.
5. Which referral would be most appropriate for the client diagnosed with thoracic outlet syndrome?
- A. The physical therapist
- B. The thoracic surgeon
- C. The occupational therapist
- D. The social worker
Correct answer: C
Rationale: The correct answer is C, the occupational therapist. An occupational therapist specializes in helping individuals with activities of daily living, ergonomic assessments, and adaptive techniques. In the case of thoracic outlet syndrome, an occupational therapist can provide exercises and adaptations to improve the client's function and alleviate symptoms. Choosing the physical therapist (choice A) may also be beneficial for rehabilitation exercises, but occupational therapists focus more on functional activities. Referring to a thoracic surgeon (choice B) would be more appropriate for surgical interventions rather than initial management. Referring to a social worker (choice D) may not directly address the physical symptoms and functional limitations associated with thoracic outlet syndrome.
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