ATI RN
ATI Fundamentals Proctored Exam 2024
1. Which of the following statements is incorrect about a patient with dysphagia?
- A. The patient will find pureed or soft foods, such as custards, easier to swallow than water
- B. Fowler’s or semi Fowler’s position reduces the risk of aspiration during swallowing
- C. The patient should always feed himself
- D. The nurse should perform oral hygiene before assisting with feeding
Correct answer: C
Rationale: The incorrect statement is that 'The patient should always feed himself.' Patients with dysphagia may require assistance with feeding due to difficulty in swallowing safely. It is essential to provide appropriate support and supervision during meal times to prevent complications such as aspiration or inadequate nutrition intake.
2. A client in the emergency department is experiencing an acute asthma attack. Which assessment indicates an improvement in respiratory status?
- A. SaO2 95%
- B. Wheezing
- C. Retraction of sternal muscles
- D. Premature ventricular complexes (PVC's)
Correct answer: SaO2 95%
Rationale: An SaO2 of 95% indicates an improvement in the client's oxygen saturation, suggesting better respiratory status. In asthma exacerbation, a decrease in SaO2 levels would signal worsening respiratory distress. Wheezing, retraction of sternal muscles, and premature ventricular complexes are indicators of respiratory compromise and worsening respiratory status in acute asthma attacks. Monitoring SaO2 levels is crucial in assessing the effectiveness of interventions and guiding treatment decisions.
3. A healthcare professional is preparing to measure an infant's temperature. Which of the following actions should the healthcare professional take?
- A. Place the tip of the thermometer under the center of the infant's axilla
- B. Pull the pinna of the infant's ear forward before inserting the probe
- C. Insert the probe 3.8 cm (1.5in) into the infant's rectum
- D. Insert the thermometer in front of the infant's tongue
Correct answer: Place the tip of the thermometer under the center of the infant's axilla
Rationale: When measuring an infant's temperature, the most appropriate and non-invasive method is to place the tip of the thermometer under the center of the infant's axilla (armpit). This method is safe, quick, and comfortable for the infant. Inserting the probe into the rectum is invasive and not recommended for routine temperature measurement in infants. Inserting the thermometer in front of the infant's tongue is not a reliable method for measuring temperature. Pulling the pinna of the ear forward is a technique used for adults, not infants.
4. A client has unilateral paralysis and dysphagia following a right hemispheric stroke. Which of the following interventions should the nurse include in the plan?
- A. Place the client's left arm on a pillow while he is sitting.
- B. Provide total care in assisting with the client's ADLs.
- C. Encourage mobility and avoid bed rest.
- D. Facilitate feeding by placing food on the left side of the client's mouth when ready to eat.
Correct answer: A: Place the client's left arm on a pillow while he is sitting.
Rationale: Placing the client's left arm on a pillow while sitting helps prevent shoulder displacement and assists in maintaining proper positioning and alignment. This intervention is crucial to prevent complications associated with immobility. Providing total care in ADLs may hinder the client's independence and recovery. Encouraging mobility is essential in preventing complications of immobility. Facilitating feeding by placing food on the unaffected side of the mouth helps reduce the risk of aspiration in clients with dysphagia.
5. Which of the following vascular system changes result from aging?
- A. Increased peripheral resistance of the blood vessels
- B. Decreased blood flow
- C. Increased workload of the left ventricle
- D. All of the above
Correct answer: D
Rationale: As individuals age, various changes occur in the vascular system. These changes include increased peripheral resistance of the blood vessels, decreased blood flow, and an increased workload of the left ventricle. Therefore, all the listed changes result from aging, making option D, 'All of the above,' the correct answer.