ATI RN
ATI Fundamentals Proctored Exam 2024
1. Which of the following scenarios represents nursing malpractice?
- A. The nurse administers penicillin to a patient with a documented history of allergy to the drug. The patient experiences an allergic reaction and suffers cerebral damage due to anoxia.
- B. The nurse applies a hot water bottle or a heating pad to the abdomen of a patient with abdominal cramping.
- C. The nurse assists a patient out of bed with the bed locked in position; the patient slips and fractures his right humerus.
- D. The nurse administers the wrong medication to a patient, resulting in vomiting. This error is documented and reported to the physician and the nursing supervisor.
Correct answer: A
Rationale: The correct answer is A. Administering a drug to a patient with a known allergy, leading to severe harm such as an allergic reaction causing cerebral damage due to anoxia, constitutes nursing malpractice. In this scenario, the nurse failed to adhere to the standard of care by administering a medication that the patient was allergic to, resulting in serious harm, which is a clear example of malpractice in nursing.
2. When providing teaching to a client with a prescription for Hydrochlorothiazide, which instruction should the nurse include?
- A. Take this medication at bedtime.
- B. Avoid foods high in potassium.
- C. Take this medication on an empty stomach.
- D. Monitor for signs of dehydration.
Correct answer: D
Rationale: The correct instruction for a client prescribed Hydrochlorothiazide is to monitor for signs of dehydration. Hydrochlorothiazide is a diuretic that can lead to fluid loss and electrolyte imbalance, potentially causing dehydration. Signs of dehydration include dry mouth, increased thirst, and decreased urine output. Therefore, it is essential for the client to be vigilant in recognizing these symptoms and seek medical attention if they occur. Choices A, B, and C are incorrect. Taking Hydrochlorothiazide at bedtime is not a specific instruction related to its effects or side effects. Avoiding foods high in potassium may be necessary for some medications, but it is not the primary concern with Hydrochlorothiazide. Taking this medication on an empty stomach is not a requirement and may vary depending on individual preferences or healthcare provider instructions.
3. A nurse is caring for a client who has Crohn's disease. Which of the following findings should the nurse expect?
- A. Weight gain.
- B. Bloody stools.
- C. Urinary retention.
- D. Abdominal distention.
Correct answer: B
Rationale: The correct answer is B: Bloody stools. Bloody stools are a common symptom of Crohn's disease, characterized by inflammation of the digestive tract. Weight gain (choice A) is less likely due to malabsorption issues associated with Crohn's disease. Urinary retention (choice C) is not directly related to Crohn's disease. Abdominal distention (choice D) may occur in Crohn's disease but is not as specific a finding as bloody stools.
4. What is the appropriate nursing intervention for a patient with suspected deep vein thrombosis (DVT)?
- A. Administer anticoagulants
- B. Encourage ambulation
- C. Apply compression stockings
- D. Monitor oxygen saturation
Correct answer: A
Rationale: The correct answer is to administer anticoagulants. Anticoagulants help prevent further clot formation in patients with suspected DVT. Encouraging ambulation can be beneficial in preventing DVT but is not the immediate intervention for a suspected case. Compression stockings are more for DVT prevention rather than treatment. Monitoring oxygen saturation is important in assessing respiratory function but is not the primary intervention for suspected DVT.
5. The healthcare provider is planning care for a patient receiving morphine sulfate via a patient-controlled analgesia pump. Which intervention may be required due to a potential adverse effect of this drug?
- A. Administering a cough suppressant
- B. Inserting a Foley catheter
- C. Administering an anti-diarrheal
- D. Monitoring urinary output
Correct answer: B
Rationale: Morphine can lead to urinary retention and urinary hesitancy. If a patient shows signs of bladder distention or inability to void, the healthcare provider should be notified, and urinary catheterization may be necessary. Administering a cough suppressant or an anti-diarrheal is not typically required to address adverse effects of morphine. Liver function tests (LFTs) are not directly related to the potential adverse effects of morphine on the urinary system.