ATI RN
ATI Fundamentals
1. During an assessment, a healthcare provider observes a client with a chest tube and drainage system. What is an expected finding?
- A. Continuous bubbling in the water seal chamber
- B. Gentle constant bubbling in the suction control chamber
- C. Drainage system positioned upright at chest level
- D. Exposed sutures without dressing
Correct answer: B
Rationale: When assessing a client with a chest tube and drainage system, gentle constant bubbling in the suction control chamber is an expected finding. This indicates that the system is functioning properly. Continuous bubbling in the water seal chamber would suggest an air leak, the drainage system should be positioned upright at chest level to promote proper drainage, and exposed sutures without dressing would be an incorrect finding as they should be covered to prevent infection.
2. What is the best description of resonance?
- A. Sounds created by air-filled structures
- B. Short, high-pitched, and thudding
- C. Moderately loud with a musical quality
- D. Drum-like
Correct answer: A
Rationale: Resonance refers to the quality of sound produced by vibrations that are reinforced by other vibrations of the same frequency. In the context of the human body, resonance is often associated with sounds produced by air-filled structures like the lungs, vocal cords, and resonating cavities. Therefore, the best description of resonance from the given options is 'Sounds created by air-filled structures.' This choice aligns with the concept of resonance as it relates to sound production in the human body. Choices B, C, and D are incorrect as they do not specifically relate to the concept of resonance or its association with air-filled structures.
3. A client has a new diagnosis of tuberculosis and has been placed on a multi-medication regimen. Which of the following instructions should the nurse give the client related to ethambutol?
- A. Your urine can turn a dark orange.
- B. Watch for a change in the sclera of your eyes.
- C. Watch for any changes in vision.
- D. Take vitamin B6 daily.
Correct answer: C
Rationale: Ethambutol is associated with potential vision changes, including optic neuritis. Patients should be instructed to report any visual disturbances immediately to prevent permanent vision loss. Monitoring for changes in vision is crucial to detect any adverse effects early on and prevent serious complications.
4. During a seizure, what is the primary intervention?
- A. Protect the patient from injury
- B. Insert an airway
- C. Elevate the head of the bed
- D. Withdraw all pain medications
Correct answer: A
Rationale: The primary intervention during a seizure is to protect the patient from injury. This involves creating a safe environment by moving harmful objects away, cushioning the head, and staying with the patient until the seizure ends. Inserting an airway is only necessary if the patient's airway is obstructed, not routinely during a seizure. Elevating the head of the bed is not a priority during an active seizure as it won't affect the seizure's outcome. Withdrawing all pain medications is not a standard practice unless there are specific contraindications related to the seizure itself.
5. A client with heart failure has a new prescription for furosemide. Which of the following statements should the nurse make?
- A. Taking furosemide can cause your potassium levels to be high
- B. Eat foods that are high in sodium
- C. Rise slowly when getting out of bed
- D. Taking furosemide can cause you to be overhydrated
Correct answer: C
Rationale: Educating the client on the importance of rising slowly when getting out of bed is crucial due to the risk of orthostatic hypotension associated with furosemide use. This precaution helps prevent dizziness and falls. Options A and D are incorrect as furosemide commonly causes hypokalemia and dehydration, respectively, rather than high potassium levels or overhydration. Option B is inaccurate as clients on furosemide need to reduce sodium intake to manage fluid retention.
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