ATI RN
ATI RN Exit Exam Test Bank
1. What is the best intervention for a patient with respiratory distress?
- A. Administer oxygen
- B. Reposition the patient
- C. Provide bronchodilators
- D. Provide humidified air
Correct answer: A
Rationale: Administering oxygen is the best intervention for a patient with respiratory distress because it helps improve oxygenation levels and alleviates respiratory distress directly. Providing oxygen addresses the primary issue of inadequate oxygen supply, which is crucial in managing respiratory distress. Repositioning the patient, while important for airway clearance, may not address the immediate need for oxygen. Providing bronchodilators and humidified air can be beneficial in certain respiratory conditions, but when a patient is in respiratory distress, ensuring adequate oxygenation through oxygen administration takes precedence.
2. While caring for a client receiving an opioid analgesic for pain management, which assessment should the nurse prioritize?
- A. Monitor the client's urinary output.
- B. Check the client's blood pressure.
- C. Assess the client for constipation.
- D. Monitor the client's respiratory rate.
Correct answer: D
Rationale: The correct answer is to monitor the client's respiratory rate. When a client is receiving opioids, the priority assessment is the respiratory rate since opioids can lead to respiratory depression. Monitoring urinary output, blood pressure, and constipation are also important but not the priority in this scenario.
3. What is the priority nursing assessment for a patient who has just returned from surgery?
- A. Monitor respiratory rate
- B. Monitor blood pressure
- C. Check the surgical site
- D. Monitor heart rate
Correct answer: A
Rationale: The correct answer is to monitor the patient's respiratory rate. This assessment is essential as it ensures that the patient is breathing adequately post-surgery. Maintaining a patent airway and adequate oxygenation are the top priorities in the immediate postoperative period. Monitoring blood pressure, checking the surgical site, or monitoring heart rate are important assessments but are not the priority immediately upon the patient's return from surgery.
4. A nurse is caring for a client who has a fecal impaction. Which action should the nurse take when digitally evacuating the stool?
- A. Insert a lubricated gloved finger and advance along the rectal wall
- B. Apply lubricant and stimulate peristalsis
- C. Apply pressure to the abdomen to assist with removal
- D. Increase fluid intake before the procedure
Correct answer: A
Rationale: The correct action when digitally evacuating a fecal impaction is to insert a lubricated gloved finger and advance along the rectal wall. This technique helps prevent trauma and effectively dislodge the impacted stool. Choice B, applying lubricant and stimulating peristalsis, is incorrect as it does not directly address the evacuation of the impacted stool. Choice C, applying pressure to the abdomen, is inappropriate and may cause discomfort or harm to the client. Choice D, increasing fluid intake before the procedure, is not directly related to the immediate evacuation of the fecal impaction.
5. A nurse is providing discharge teaching to a client who is recovering from a myocardial infarction. Which of the following client statements indicates a need for further teaching?
- A. I will take a daily aspirin to prevent another heart attack.
- B. I should expect to experience chest pain when I exercise.
- C. I will increase my intake of saturated fats.
- D. I will participate in a cardiac rehabilitation program.
Correct answer: C
Rationale: The correct answer is C. Increasing the intake of saturated fats can raise cholesterol levels, which is not recommended after a myocardial infarction. Choices A, B, and D are all appropriate statements indicating a good understanding of post-myocardial infarction care. Taking a daily aspirin can help prevent another heart attack, experiencing chest pain with exercise is a common expectation post-myocardial infarction, and participating in a cardiac rehabilitation program is important for recovery and improving heart health.
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