ATI RN
ATI Gastrointestinal System Test
1. When planning care for a client with ulcerative colitis who is experiencing symptoms, which client care activities can the nurse appropriately delegate to a unlicensed assistant?
- A. Assessing the client’s bowel sounds
- B. Providing skin care following bowel movements
- C. Evaluating the client’s response to antidiarrheal medications
- D. Maintaining intake and output records
Correct answer: B, D, E
Rationale: Delegating tasks such as providing skin care, maintaining intake and output records, and obtaining the client's weight are within the scope of practice for an unlicensed assistant. Assessing bowel sounds and evaluating the response to medications require nursing judgment and should not be delegated.
2. What is the primary consideration of susceptibility to infections in neonates?
- A. Increased humoral immunity
- B. Overwhelming anti-inflammatory response
- C. Diminished nonspecific and specific immunity
- D. Excessive levels of immunoglobulin A and immunoglobulin M
Correct answer: C
Rationale: The primary consideration of susceptibility to infections in neonates is their diminished nonspecific and specific immunity. Neonates lack the ability to mount a robust immune response, making them vulnerable to infections. Choice A is incorrect because neonates do not have increased humoral immunity; rather, their humoral immunity is diminished. Choice B is incorrect as neonates do not have an overwhelming anti-inflammatory response; instead, their immune responses are generally weakened. Choice D is incorrect because neonates have diminished or absent levels of immunoglobulin A and immunoglobulin M, contributing to their susceptibility to infections.
3. A nurse is caring for a client who is postoperative following abdominal surgery. Which of the following findings should the nurse report to the provider?
- A. Serous drainage at the incision site
- B. Temperature 38.2°C (100.8°F)
- C. Heart rate 92/min
- D. Blood pressure 130/80 mm Hg
Correct answer: B
Rationale: The correct answer is B. An elevated temperature of 38.2°C (100.8°F) indicates a potential infection and should be reported to the provider. Elevated temperature postoperatively is often a sign of infection or inflammation, which can delay healing and increase the risk of complications. Choices A, C, and D are within normal ranges for a postoperative client and do not indicate an immediate need for reporting to the provider. Serous drainage at the incision site is expected in the initial postoperative period as part of the normal healing process, a heart rate of 92/min can be a normal response to surgery due to stress or pain, and a blood pressure of 130/80 mm Hg is also within normal limits for most clients.
4. The nurse is caring for a patient from a culture unfamiliar to the local area. The best way for a culturally competent nurse to interact with the family is to:
- A. Explain that the child must now be cared for differently
- B. Speak in the language most used by the staff and encourage the family to learn it
- C. Be respectful and open-minded when discussing beliefs
- D. Insist that the family changes their beliefs
Correct answer: C
Rationale: The best way for a culturally competent nurse to interact with a family from an unfamiliar culture is to be respectful and open-minded when discussing beliefs. This approach demonstrates cultural competence by honoring and valuing the family's beliefs and practices. Choice A is incorrect as it disregards the family's cultural practices without understanding them. Choice B is not the best approach as it focuses on language rather than respecting beliefs. Choice D is inappropriate as it goes against the principles of cultural competence by imposing beliefs on the family.
5. What is the sequence in which growth starts at the center of the body and moves toward the extremities?
- A. Cephalocaudal pattern
- B. Proximodistal pattern
- C. Cephamodistal pattern
- D. Gene-environment correlation
Correct answer: B
Rationale: The correct answer is B: Proximodistal pattern. This pattern describes growth starting at the center of the body and moving towards the extremities. Choice A, Cephalocaudal pattern, refers to growth starting from the head and moving downwards, which is not the sequence described in the question. Choice D, Gene-environment correlation, does not relate to the sequential pattern of growth described in the question, making it incorrect.
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