ATI RN
ATI Comprehensive Exit Exam 2023 With NGN Quizlet
1. A healthcare professional is receiving a change-of-shift report for an adult female client who is postoperative. Which client information should the healthcare professional report?
- A. Low-grade fever.
- B. Shortness of breath.
- C. Decreased urine output.
- D. High platelet count.
Correct answer: A
Rationale: In a postoperative client, a low-grade fever can be an early sign of infection, which is crucial to report to the healthcare team for timely intervention. Shortness of breath and decreased urine output are also important to monitor, but in the context of postoperative care, infection is a more immediate concern. A high platelet count is not typically a priority in the immediate postoperative period.
2. A client with a nasogastric tube receiving continuous enteral feedings is at risk for aspiration. Which of the following actions should the nurse take to prevent aspiration?
- A. Elevate the head of the bed to 15 degrees
- B. Check gastric residual volumes every 6 hours
- C. Monitor the pH of gastric aspirate
- D. Instill 10 mL of air into the tube before feeding
Correct answer: B
Rationale: Checking gastric residual volumes every 6 hours is essential in preventing aspiration in clients receiving continuous enteral feedings. This practice helps determine if the stomach is adequately emptying, reducing the risk of regurgitation and aspiration. Elevating the head of the bed to 30 degrees, not 15 degrees, is recommended to further prevent aspiration by reducing the risk of reflux. Monitoring the pH of gastric aspirate is important to assess tube placement but does not directly prevent aspiration. Instilling air into the tube before feeding is not a recommended practice and does not prevent aspiration.
3. A nurse in a pediatric clinic is reviewing laboratory findings for a school-age child. Which of the following findings should the nurse report to the provider?
- A. Hgb 12.5 g/dL
- B. Platelets 250,000/mm3
- C. WBC 14,000/mm3
- D. Hct 40%
Correct answer: D
Rationale: The correct answer is D: 'Hct 40%'. An abnormal hematocrit (Hct) level can indicate various conditions such as dehydration, overhydration, or blood disorders, and requires immediate attention from the healthcare provider. Choices A, B, and C are within normal ranges and do not typically warrant immediate provider notification. Hgb 12.5 g/dL (Choice A) is a normal hemoglobin level, Platelets 250,000/mm3 (Choice B) is a normal platelet count, and WBC 14,000/mm3 (Choice C) is slightly elevated but not significantly high to require urgent reporting.
4. A nurse is caring for a client who has acute pancreatitis. Which of the following interventions should the nurse take?
- A. Encourage oral intake of clear liquids
- B. Administer an antiemetic before meals
- C. Insert a nasogastric tube for suction
- D. Place the client in a supine position
Correct answer: C
Rationale: In acute pancreatitis, the gastrointestinal tract needs to rest to reduce pancreatic enzyme secretion. Inserting a nasogastric tube for suction helps decompress the stomach and reduce stimulation of the pancreas. Encouraging oral intake of clear liquids (Choice A) or administering an antiemetic before meals (Choice B) may aggravate the condition by stimulating the pancreas. Placing the client in a supine position (Choice D) may not directly address the underlying issue of reducing pancreatic stimulation.
5. A nurse is caring for a client who is receiving continuous enteral feedings through a nasogastric tube. Which of the following actions should the nurse take?
- A. Keep the head of the bed elevated to 15 degrees.
- B. Change the feeding bag every 48 hours.
- C. Administer the feeding through a large-bore syringe.
- D. Flush the tube with 0.9% sodium chloride every 4 hours.
Correct answer: D
Rationale: The correct action the nurse should take is to flush the tube with 0.9% sodium chloride every 4 hours. This helps maintain patency and prevents clogs during enteral feedings. Keeping the head of the bed elevated to 15 degrees (Choice A) is important for preventing aspiration but is not directly related to tube care. Changing the feeding bag every 48 hours (Choice B) is not a standard practice as the bag should be changed every 24 hours to prevent bacterial growth. Administering the feeding through a large-bore syringe (Choice C) is incorrect as enteral feedings should be given through an appropriate feeding pump for accuracy and safety.
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