ATI RN
ATI Exit Exam 2024
1. A nurse is caring for a client who has a new diagnosis of tuberculosis (TB). Which of the following interventions should the nurse include in the plan of care?
- A. Place the client in a private room with negative airflow.
- B. Wear an N95 respirator when caring for the client.
- C. Place the client in a positive pressure room.
- D. Maintain the client on droplet precautions.
Correct answer: A
Rationale: The correct answer is to place the client in a private room with negative airflow. This is crucial for preventing the spread of tuberculosis (TB) infection. Option B, wearing an N95 respirator when caring for the client, is important for staff protection but does not address the need for isolation precautions. Option C, placing the client in a positive pressure room, is incorrect as TB clients should be in negative pressure rooms to prevent the spread of airborne pathogens. Option D, maintaining the client on droplet precautions, is not sufficient for TB, which requires airborne precautions.
2. A client with diabetes mellitus receiving regular insulin should be monitored for which of the following manifestations of hypoglycemia?
- A. Bradycardia.
- B. Dry skin.
- C. Increased thirst.
- D. Increased urinary output.
Correct answer: A
Rationale: The correct answer is A, Bradycardia. Bradycardia is a common sign of hypoglycemia, which can occur as a complication of insulin therapy in clients with diabetes mellitus. Dry skin (choice B) is not typically associated with hypoglycemia. Increased thirst (choice C) and increased urinary output (choice D) are symptoms more commonly seen in conditions like hyperglycemia or diabetes insipidus, not hypoglycemia.
3. A client is receiving intermittent tube feedings and is at risk for aspiration. What should the nurse identify as a risk factor?
- A. A residual of 65mL 1 hour postprandial.
- B. History of gastroesophageal reflux disease.
- C. Receiving a high-osmolarity formula.
- D. Receiving a feeding in a supine position.
Correct answer: B
Rationale: The correct answer is B: History of gastroesophageal reflux disease. Gastroesophageal reflux disease increases the risk of aspiration due to the potential for regurgitation of stomach contents into the esophagus and airways. Choices A, C, and D are not directly related to an increased risk of aspiration. A residual of 65mL 1 hour postprandial may indicate delayed gastric emptying but is not a direct risk factor for aspiration. Receiving a high-osmolarity formula or receiving a feeding in a supine position are not specific risk factors for aspiration unless they contribute to reflux or other related issues.
4. A nurse is assessing a client who is postoperative following a thyroidectomy. The nurse should identify which of the following findings as an indication of hypocalcemia?
- A. Tingling in the fingers.
- B. Elevated blood pressure.
- C. Positive Chvostek's sign.
- D. Positive Kernig's sign.
Correct answer: A
Rationale: The correct answer is A: Tingling in the fingers. Tingling in the fingers is a common sign of hypocalcemia, often seen after a thyroidectomy. Hypocalcemia can occur post-thyroidectomy due to inadvertent damage or removal of the parathyroid glands which regulate calcium levels. Choices B, C, and D are incorrect. Elevated blood pressure is not typically associated with hypocalcemia. Positive Chvostek's sign is a clinical sign of hypocalcemia but is usually assessed as facial muscle twitching, not tingling in the fingers. Positive Kernig's sign is a test for meningitis, not related to hypocalcemia.
5. A nurse is caring for a client who has bipolar disorder and is experiencing acute mania. The nurse obtained a verbal prescription for restraints. Which of the following actions should the nurse take?
- A. Request a renewal of the prescription every 8 hours.
- B. Check the client's peripheral pulse rate every 30 minutes.
- C. Obtain a prescription for restraint within 4 hours.
- D. Document the client's condition every 15 minutes.
Correct answer: C
Rationale: Obtaining a prescription for restraint within 4 hours is the correct action when managing restraints in a client with acute mania. This timeframe ensures that the use of restraints is promptly evaluated and authorized by a healthcare provider. Requesting a renewal of the prescription every 8 hours (Choice A) is not necessary and may delay appropriate care. Checking the client's peripheral pulse rate every 30 minutes (Choice B) is important but not the immediate priority when dealing with obtaining a prescription for restraints. Documenting the client's condition every 15 minutes (Choice D) is essential for monitoring, but the priority is to secure a prescription for restraints promptly.
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