ATI RN
ATI Exit Exam 180 Questions Quizlet
1. A nurse is assessing a client who has a deep vein thrombosis (DVT). Which of the following findings should the nurse report to the provider?
- A. Calf tenderness.
- B. Shortness of breath.
- C. Elevated blood pressure.
- D. Respiratory rate of 18/min.
Correct answer: B
Rationale: Shortness of breath is a critical finding that can indicate a pulmonary embolism, a severe complication of DVT. This symptom suggests a potential life-threatening situation and requires immediate intervention. Calf tenderness, while common in DVT, is not as urgent as shortness of breath. Elevated blood pressure and a respiratory rate of 18/min are important to assess but are not typically as indicative of a serious complication like a pulmonary embolism.
2. A nurse is assessing a client who has been taking haloperidol for several years. Which of the following assessment findings should the nurse recognize as a long-term side effect of this medication?
- A. Lipsmacking
- B. Agranulocytosis
- C. Clang association
- D. Alopecia
Correct answer: A
Rationale: Lipsmacking is a common sign of tardive dyskinesia, a long-term side effect of haloperidol. Tardive dyskinesia is characterized by repetitive, involuntary, purposeless movements such as lipsmacking, tongue protrusion, and facial grimacing. Agranulocytosis (choice B) is a potential side effect of antipsychotic medications but is not specifically associated with haloperidol. Clang association (choice C) is a form of disorganized speech seen in conditions like schizophrenia but is not a side effect of haloperidol. Alopecia (choice D) refers to hair loss and is not a common long-term side effect of haloperidol.
3. A nurse is caring for a client who is at risk for developing pressure ulcers. Which of the following interventions should the nurse implement?
- A. Use a donut-shaped cushion for sitting
- B. Turn the client every 4 hours
- C. Elevate the head of the bed to 45 degrees
- D. Massage reddened areas to increase circulation
Correct answer: C
Rationale: Elevating the head of the bed reduces pressure on bony prominences, which helps prevent pressure ulcers.
4. A client has a new prescription for metformin. Which of the following client statements indicates an understanding of the teaching?
- A. ''I will take this medication at bedtime to avoid nausea.''
- B. ''I should take this medication with a full glass of water in the morning.''
- C. ''I should avoid eating foods that contain iodine.''
- D. ''I should take this medication with food to improve absorption.''
Correct answer: B
Rationale: The correct answer is B. Metformin should be taken with a full glass of water in the morning to improve absorption and prevent gastrointestinal upset. Choice A is incorrect because metformin is not typically taken at bedtime. Choice C is unrelated to metformin therapy. Choice D is incorrect because metformin is actually better absorbed when taken with or after meals.
5. What is the appropriate action when a patient experiences an allergic reaction to a medication?
- A. Administer epinephrine
- B. Discontinue the medication
- C. Administer corticosteroids
- D. Administer antihistamines
Correct answer: A
Rationale: The correct answer is to administer epinephrine. Epinephrine is the first-line treatment for a severe allergic reaction as it helps to constrict blood vessels, increase heart rate, and open airways, thereby improving breathing and circulation. Discontinuing the medication may not be sufficient to manage a severe allergic reaction as the allergen is already in the patient's system. Corticosteroids and antihistamines can be considered as complementary treatments but are not the primary immediate intervention required for a severe allergic reaction.
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