ATI RN
ATI RN Comprehensive Exit Exam
1. What is the best method to manage fluid overload in a patient with heart failure?
- A. Administer diuretics
- B. Provide oral fluids
- C. Increase fluid intake
- D. Provide chest physiotherapy
Correct answer: A
Rationale: Administering diuretics is the best method to manage fluid overload in a patient with heart failure. Diuretics help to remove excess fluid from the body by increasing urine output, thus reducing the fluid volume in the bloodstream and tissues. Providing oral fluids (choice B) or increasing fluid intake (choice C) would exacerbate the fluid overload rather than managing it. Chest physiotherapy (choice D) is not indicated for managing fluid overload in heart failure; it is more commonly used for conditions affecting the lungs or airways.
2. A client is being discharged with a new prescription for levothyroxine. Which of the following instructions should the nurse include?
- A. Take this medication with meals to avoid stomach upset.
- B. Take this medication at the same time every day.
- C. Notify your provider if you experience chest pain or palpitations.
- D. Take this medication with antacids to reduce indigestion.
Correct answer: B
Rationale: The correct answer is B: 'Take this medication at the same time every day.' It is crucial to take levothyroxine at the same time each day to maintain consistent thyroid hormone levels. Choice A is incorrect because levothyroxine should be taken on an empty stomach, usually in the morning. Choice C is important but not specific to the administration of levothyroxine. Choice D is incorrect as antacids can interfere with the absorption of levothyroxine.
3. A nurse is caring for a client who is 12 hr postpartum and has a third-degree perineal laceration. The client reports not having a bowel movement for 4 days. Which of the following medications should the nurse administer?
- A. Bisacodyl 10 mg rectal suppository.
- B. Magnesium hydroxide 30 ml PO.
- C. Famotidine 20 mg PO.
- D. Loperamide 4 mg PO.
Correct answer: A
Rationale: In this scenario, the nurse should administer Bisacodyl 10 mg rectal suppository. Bisacodyl is a stimulant laxative that promotes bowel movement, which is appropriate for a postpartum client experiencing constipation. Magnesium hydroxide (choice B) is an antacid and not indicated for constipation. Famotidine (choice C) is an H2 receptor antagonist used for reducing stomach acid production, not for constipation. Loperamide (choice D) is an antidiarrheal agent and would worsen constipation in this case.
4. A nurse is caring for a client who is 1 day postoperative following abdominal surgery. Which of the following findings should the nurse report to the provider?
- A. Serosanguineous drainage on the surgical dressing.
- B. Heart rate of 88/min.
- C. Blood pressure of 118/76 mm Hg.
- D. Temperature of 38.8°C (101.8°F).
Correct answer: D
Rationale: A temperature of 38.8°C (101.8°F) is above the normal range and may indicate infection, which should be reported. Elevated temperature postoperatively can be a sign of infection, especially in the early postoperative period. Serosanguineous drainage on the surgical dressing is expected in the early postoperative period. A heart rate of 88/min and a blood pressure of 118/76 mm Hg are within normal ranges and do not necessarily indicate a complication postoperatively.
5. A client with vision loss is being cared for by a nurse. Which of the following actions should the nurse take?
- A. Keep objects in the client's room in the same place
- B. Ensure there is high-wattage lighting in the client's room
- C. Approach the client from the side
- D. Touch the client gently to announce presence
Correct answer: A
Rationale: The correct action for the nurse to take is to keep objects in the client's room in the same place. This helps individuals with vision loss navigate their environment more easily by creating a familiar and consistent layout. Choice B, ensuring high-wattage lighting, may not be suitable for all clients with vision loss and can cause discomfort or glare. Approaching the client from the side (Choice C) can startle them and is not recommended. Touching the client (Choice D) without warning may cause anxiety or distress, so it's important to announce presence verbally.
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