ATI RN
ATI RN Comprehensive Exit Exam
1. What is the best position for a patient experiencing shortness of breath?
- A. Supine position
- B. Semi-Fowler's position
- C. Trendelenburg position
- D. Prone position
Correct answer: B
Rationale: The best position for a patient experiencing shortness of breath is the Semi-Fowler's position. This position promotes lung expansion and improves oxygenation by allowing the chest to expand more fully. The Supine position (lying flat on the back) may worsen breathing difficulties by reducing lung capacity. The Trendelenburg position (feet elevated higher than the head) is not recommended for patients with shortness of breath as it can increase pressure on the diaphragm and compromise breathing. The Prone position (lying face down) is also not suitable for patients experiencing shortness of breath as it may further restrict breathing.
2. A nurse is caring for a client who has a chest tube following thoracic surgery. Which of the following actions should the nurse take?
- A. Clamp the chest tube when assisting the client out of bed.
- B. Empty the drainage system every 8 hours.
- C. Keep the collection device below the client's chest.
- D. Strip the chest tube every 4 hours.
Correct answer: C
Rationale: The correct action for the nurse to take is to keep the collection device below the client's chest. This positioning ensures proper drainage of fluid from the chest, preventing backflow of fluids. Clamping the chest tube when assisting the client out of bed is incorrect as it can lead to fluid accumulation and potential complications. Emptying the drainage system every 8 hours is necessary but not the priority over maintaining proper positioning. Stripping the chest tube every 4 hours is an outdated practice and can cause damage to the tissue and should be avoided.
3. What is the best intervention for a patient with suspected deep vein thrombosis (DVT)?
- A. Administer anticoagulants
- B. Apply compression stockings
- C. Encourage ambulation
- D. Monitor oxygen saturation
Correct answer: A
Rationale: The best intervention for a patient with suspected deep vein thrombosis (DVT) is to administer anticoagulants. Anticoagulants help prevent further clot formation and reduce the risk of complications such as pulmonary embolism. Applying compression stockings can help manage symptoms but does not address the underlying issue of clot formation. Encouraging ambulation is beneficial for overall circulation but may not be sufficient to treat DVT. Monitoring oxygen saturation is important, but it is not the primary intervention for suspected DVT.
4. A nurse is caring for a client who has heart failure and is receiving a continuous IV infusion of furosemide. Which of the following findings indicates the nurse should increase the client's infusion rate?
- A. Urine output of 20 mL/hr
- B. Heart rate of 90/min
- C. Sodium level of 138 mEq/L
- D. Weight gain of 1 kg in 24 hr
Correct answer: D
Rationale: A weight gain of 1 kg in 24 hours can indicate fluid retention and worsening heart failure, requiring an increase in diuresis. This finding suggests that the current diuretic therapy is not effective enough to manage the fluid overload, necessitating an increase in the infusion rate of furosemide. Choices A, B, and C are not directly related to the need for an increase in diuretic therapy in heart failure patients. Urine output of 20 mL/hr, a heart rate of 90/min, and a sodium level of 138 mEq/L are important parameters to monitor but do not specifically indicate the need to increase the infusion rate of furosemide.
5. A nurse is providing dietary teaching to a client who has a new diagnosis of hypertension. Which of the following foods should the nurse instruct the client to avoid?
- A. Canned soup.
- B. Lean cuts of beef.
- C. Bananas.
- D. Baked chicken.
Correct answer: A
Rationale: The correct answer is A: Canned soup. Canned soups are usually high in sodium, which can increase blood pressure and should be avoided by clients with hypertension. Lean cuts of beef, bananas, and baked chicken are healthier options for individuals with hypertension as they are lower in sodium and can be included in a balanced diet to manage blood pressure levels.
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