ATI RN
ATI RN Comprehensive Exit Exam 2023
1. What is the priority nursing assessment for a patient with chronic kidney disease?
- A. Monitor serum creatinine
- B. Monitor blood pressure
- C. Monitor urine output
- D. Monitor potassium levels
Correct answer: A
Rationale: The correct answer is to monitor serum creatinine. In patients with chronic kidney disease, monitoring serum creatinine is crucial as it reflects kidney function. This assessment helps healthcare providers in evaluating the progression of the disease and adjusting treatment plans accordingly. Monitoring blood pressure (choice B) is essential in managing chronic kidney disease, but monitoring serum creatinine takes precedence. Monitoring urine output (choice C) and potassium levels (choice D) are also important aspects of managing chronic kidney disease, but they are not the priority assessment compared to monitoring serum creatinine.
2. A nurse is caring for a client who is postoperative following a hip arthroplasty. Which of the following actions should the nurse take to prevent dislocation of the prosthesis?
- A. Place a pillow between the client's legs.
- B. Place the client in a high Fowler's position.
- C. Maintain the client in a side-lying position.
- D. Keep the client's legs elevated.
Correct answer: A
Rationale: Placing a pillow between the client's legs is the correct action to prevent dislocation of the prosthesis after hip arthroplasty. This positioning helps maintain proper alignment and stability of the hip joint, reducing the risk of dislocation. Placing the client in a high Fowler's position (choice B) is not recommended after hip arthroplasty as it may strain the hip joint. Maintaining the client in a side-lying position (choice C) or keeping the client's legs elevated (choice D) does not provide the same level of support and alignment as placing a pillow between the legs.
3. A client is at risk for developing deep vein thrombosis (DVT). Which of the following actions should the nurse take?
- A. Encourage the client to remain on bed rest.
- B. Massage the client's legs every 4 hours.
- C. Apply sequential compression devices to the client's legs.
- D. Administer anticoagulants as prescribed.
Correct answer: C
Rationale: The correct action the nurse should take for a client at risk for developing DVT is to apply sequential compression devices to the client's legs. This intervention helps prevent venous stasis by promoting circulation and reducing the risk of DVT. Encouraging the client to remain on bed rest (Choice A) can actually increase the risk of DVT due to immobility. Massaging the client's legs every 4 hours (Choice B) can dislodge blood clots and is contraindicated in DVT prevention. While administering anticoagulants as prescribed (Choice D) is a treatment for DVT, it is not a preventive measure for a client at risk.
4. A nurse is teaching a newly licensed nurse about the stages of wound healing. The nurse should include in the teaching that collagen is added to the wound during which of the following stages?
- A. Hemostasis phase.
- B. Inflammatory phase.
- C. Proliferative phase.
- D. Maturation phase.
Correct answer: C
Rationale: The correct answer is C: Proliferative phase. During the proliferative phase of wound healing, collagen is added to the wound to promote tissue regeneration. In the hemostasis phase (choice A), the primary goal is to stop bleeding by forming a blood clot. The inflammatory phase (choice B) involves cleaning the wound and preparing it for healing. The maturation phase (choice D) is when the wound undergoes remodeling and gains strength, but collagen addition primarily occurs during the proliferative phase.
5. A nurse is providing discharge teaching to a client who has a new prescription for digoxin. Which of the following statements by the client indicates an understanding of the teaching?
- A. I will take my pulse before taking this medication.
- B. I should take this medication with food to prevent nausea.
- C. I will take this medication if my heart rate is less than 60/min.
- D. I should take this medication with food if I am not feeling well.
Correct answer: A
Rationale: The correct answer is A. Taking the pulse before taking digoxin is crucial as it helps monitor the heart rate, as digoxin can cause bradycardia as a side effect. Option B is incorrect because digoxin should be taken on an empty stomach to enhance absorption. Option C is incorrect because digoxin should be held and the healthcare provider should be contacted if the heart rate is less than 60/min. Option D is incorrect because digoxin should not be taken with food due to decreased absorption.
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