ATI RN
ATI RN Exit Exam Quizlet
1. What is the appropriate action when a patient refuses treatment for religious reasons?
- A. Respect the patient's decision
- B. Persuade the patient to accept treatment
- C. Inform the healthcare provider
- D. Document the refusal
Correct answer: A
Rationale: The correct answer is to respect the patient's decision. When a patient refuses treatment for religious reasons, it is crucial to respect their autonomy and beliefs. Persuading the patient to accept treatment could violate their rights and autonomy, going against ethical principles. Informing the healthcare provider is important, but the immediate action should be to respect the patient's decision first. Documenting the refusal is necessary for legal and documentation purposes, but it should not override respecting the patient's autonomy and right to refuse treatment based on religious beliefs.
2. A nurse is caring for a client who is 36 hours postoperative following abdominal surgery. Which of the following findings should the nurse report to the provider?
- A. Heart rate of 92/min
- B. Serosanguineous wound drainage
- C. Yellow wound drainage
- D. Blood pressure of 118/76 mm Hg
Correct answer: C
Rationale: Yellow wound drainage can indicate infection, especially 36 hours postoperative, and should be reported to the provider promptly. Serosanguineous drainage is a normal finding in the early stages of wound healing, and a heart rate of 92/min and a blood pressure of 118/76 mm Hg are within normal ranges for a postoperative client. Therefore, the nurse should prioritize reporting the yellow wound drainage as it may require immediate intervention.
3. What is the most appropriate method to assess a patient's level of consciousness?
- A. Use the Glasgow Coma Scale
- B. Assess the patient's orientation
- C. Check pupillary response
- D. Monitor vital signs
Correct answer: A
Rationale: The correct answer is A: Using the Glasgow Coma Scale. The Glasgow Coma Scale is a standardized tool used to assess a patient's level of consciousness by evaluating their eye response, verbal response, and motor response. This scale provides a numeric value that helps in determining the severity of brain injury or altered mental status. Choices B, C, and D are incorrect because while assessing the patient's orientation, checking pupillary response, and monitoring vital signs are important components of a comprehensive patient assessment, they do not specifically target the assessment of consciousness level, which is best done using the Glasgow Coma Scale.
4. A nurse is planning care for a client who is postoperative following a bowel resection. Which of the following interventions should the nurse include?
- A. Encourage the client to drink adequate fluids daily.
- B. Administer pain medication as needed.
- C. Instruct the client to splint the incision with a pillow.
- D. Encourage the client to eat a balanced diet.
Correct answer: C
Rationale: The correct intervention for a client post-bowel resection is to instruct the client to splint the incision with a pillow. This technique helps prevent dehiscence, which is the separation of wound edges, and reduces pain when coughing or moving. Splinting supports the incision site, decreasing tension on the wound. Encouraging the client to drink adequate fluids promotes hydration and aids in recovery, but a specific volume like 1,000 mL mentioned in choice A is not essential. Pain medication should be administered as needed for adequate pain control, not necessarily before every meal. Instructing the client to eat a balanced diet, including adequate protein, is crucial for wound healing and overall recovery, rather than limiting protein intake.
5. During an in-service about nursing leadership, what information should the nurse include about an effective leader?
- A. Acts as an advocate for the nursing unit.
- B. Prioritizes staff requests over client needs.
- C. Shares personal opinions to influence the group's values.
- D. Provides routine client care and documentation.
Correct answer: A
Rationale: An effective leader advocates for the unit's success and its members. Choice B is incorrect because prioritizing staff requests over client needs does not align with effective leadership, which should focus on client-centered care. Choice C is incorrect as sharing personal opinions to influence the group's values can be biased and may not reflect the best interest of the team. Choice D is incorrect because while providing client care is essential, effective leadership involves more than routine tasks and includes guiding and supporting the team.
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