ATI RN
ATI Exit Exam RN
1. What is the best method to monitor fluid balance in a patient receiving diuretics?
- A. Monitor daily weight
- B. Monitor intake and output
- C. Monitor blood pressure
- D. Monitor edema
Correct answer: A
Rationale: The best method to monitor fluid balance in a patient receiving diuretics is to monitor daily weight. Daily weighing is a precise way to assess changes in fluid status as it reflects variations in total body water. Monitoring intake and output (choice B) is also important but may not provide as accurate a measurement as daily weight. Monitoring blood pressure (choice C) is essential but does not directly measure fluid balance. Monitoring edema (choice D) is helpful to assess fluid status visually but may not be as sensitive as daily weight measurements in detecting subtle changes in fluid balance.
2. A nurse is providing dietary teaching to a client with irritable bowel syndrome (IBS). Which of the following recommendations should the nurse include?
- A. Consume foods high in bran fiber.
- B. Increase intake of milk products.
- C. Sweeten foods with fructose corn syrup.
- D. Increase intake of foods high in gluten.
Correct answer: A
Rationale: The correct recommendation for a client with irritable bowel syndrome (IBS) is to consume foods high in bran fiber. Bran fiber promotes regularity and helps reduce IBS symptoms by aiding digestion and preventing constipation. Choices B, C, and D are incorrect. Increasing intake of milk products may exacerbate IBS symptoms in some individuals due to lactose intolerance. Sweetening foods with fructose corn syrup can worsen IBS symptoms as it may cause bloating and gas. Increasing intake of foods high in gluten may also be problematic for individuals with IBS as gluten-containing foods can trigger symptoms like abdominal pain and diarrhea.
3. A nurse is reviewing the medical record of a client who is 24 hours postoperative following abdominal surgery. Which of the following findings should the nurse report to the provider?
- A. Heart rate 90/min
- B. Serosanguineous drainage in the surgical drain
- C. Temperature 38.6°C (101.5°F)
- D. Urinary output 60 mL/hr
Correct answer: C
Rationale: The correct answer is C. A temperature of 38.6°C (101.5°F) is above the normal range and indicates a fever, which is a concerning finding postoperatively. Fever can be a sign of infection, so the nurse should report this finding to the provider for further evaluation and intervention. Choices A, B, and D are within expected parameters for a client who is 24 hours postoperative following abdominal surgery and do not require immediate reporting. A heart rate of 90/min, serosanguineous drainage in the surgical drain, and a urinary output of 60 mL/hr are all common postoperative findings that do not raise immediate concerns.
4. A client has a new prescription for furosemide. Which of the following instructions should the nurse include?
- A. Avoid foods high in potassium while taking this medication.
- B. This medication may cause your blood pressure to increase.
- C. This medication can cause you to retain fluids.
- D. Take this medication with meals.
Correct answer: D
Rationale: The correct instruction for a client taking furosemide is to take the medication with meals. This helps prevent gastrointestinal upset and improves medication tolerance. Option A is incorrect because furosemide is a loop diuretic that can cause potassium depletion, so avoiding foods high in potassium is not necessary. Option B is incorrect as furosemide typically lowers blood pressure. Option C is incorrect because furosemide is a diuretic that promotes fluid loss rather than retention.
5. What is the priority nursing action for a patient with confusion post-surgery?
- A. Administer oxygen
- B. Reposition the patient
- C. Check oxygen saturation
- D. Perform a neurological exam
Correct answer: A
Rationale: The correct answer is to administer oxygen. Post-surgery, confusion in a patient could be due to hypoxia, a condition where the body is deprived of an adequate oxygen supply. Administering oxygen helps address hypoxia promptly, improving oxygen levels in the body and potentially resolving the confusion. Repositioning the patient, checking oxygen saturation, and performing a neurological exam may be important interventions but addressing hypoxia with oxygen administration takes precedence as the priority action.
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