ATI RN
ATI RN Exit Exam Test Bank
1. What is the most appropriate intervention for a patient with a suspected stroke?
- A. Administer IV fluids
- B. Perform a CT scan
- C. Perform a lumbar puncture
- D. Administer anticoagulants
Correct answer: B
Rationale: The most appropriate intervention for a patient with a suspected stroke is to perform a CT scan. A CT scan is crucial for diagnosing a stroke by visualizing any bleeding or blockages in the brain. Administering IV fluids (Choice A) may be necessary based on the patient's condition, but it is not the primary intervention for a suspected stroke. Performing a lumbar puncture (Choice C) is not indicated for stroke evaluation and may not provide relevant information. Administering anticoagulants (Choice D) is a treatment option for certain types of strokes but should be based on the CT scan results and specific guidelines.
2. A healthcare provider is caring for a client who has been diagnosed with sepsis. Which of the following laboratory results indicates that the client is developing disseminated intravascular coagulation (DIC)?
- A. Elevated hemoglobin
- B. Elevated white blood cell count
- C. Decreased fibrinogen level
- D. Decreased platelet count
Correct answer: D
Rationale: The correct answer is D, decreased platelet count. In disseminated intravascular coagulation (DIC), there is widespread activation of clotting factors leading to the formation of multiple blood clots throughout the body, which can deplete platelets. A decreased platelet count is a hallmark of DIC. Elevated hemoglobin (choice A) and elevated white blood cell count (choice B) are not specific indicators of DIC. While fibrinogen levels (choice C) can be decreased in DIC due to consumption, a decreased platelet count is a more specific and early sign of DIC development.
3. A client has deep vein thrombosis (DVT). Which of the following actions should the nurse take?
- A. Administer thrombolytics as prescribed.
- B. Massage the affected extremity every 2 hours.
- C. Apply warm compresses to the affected extremity.
- D. Place the client in a supine position with the legs elevated.
Correct answer: C
Rationale: The correct action for a nurse caring for a client with deep vein thrombosis (DVT) is to apply warm compresses to the affected extremity. Warm compresses help reduce swelling and pain in clients with DVT. Administering thrombolytics (Choice A) is not typically done without specific orders due to the risk of bleeding. Massaging the affected extremity (Choice B) can dislodge blood clots and lead to complications. Placing the client in a supine position with the legs elevated (Choice D) may increase the risk of clot dislodgment.
4. A client who is postoperative following a total hip arthroplasty is at risk for hip dislocation. Which of the following actions should the nurse take to prevent this complication?
- A. Position the client supine with a pillow between the legs
- B. Place a pillow under the client's knees
- C. Place an abduction pillow between the client's legs
- D. Place a trochanter roll under the client's legs
Correct answer: C
Rationale: After a total hip arthroplasty, it is crucial to prevent hip dislocation. Placing an abduction pillow between the client's legs helps maintain proper alignment and prevents the hip from dislocating. This position aids in keeping the hip in a neutral or slightly outwardly rotated position, reducing the risk of dislocation. Placing the client supine with a pillow between the legs (Choice A) or using a trochanter roll (Choice D) may not provide the same level of abduction and support needed to prevent hip dislocation. Placing a pillow under the client's knees (Choice B) does not provide the necessary support to maintain proper hip alignment in this situation.
5. What is the appropriate action for a patient experiencing chest pain?
- A. Administer aspirin
- B. Reposition the patient
- C. Check oxygen saturation
- D. Prepare for surgery
Correct answer: A
Rationale: The correct action for a patient experiencing chest pain is to administer aspirin. Aspirin helps reduce the risk of clot formation in patients with chest pain, as it has antiplatelet effects. Repositioning the patient may not address the underlying cause of the chest pain. Checking oxygen saturation is important but not the initial priority in this scenario. Surgery is not typically the first-line treatment for chest pain without further assessment and diagnostic procedures.
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