ATI RN
ATI Comprehensive Exit Exam 2023
1. A nurse is assessing a client who is receiving enteral nutrition via a nasogastric tube. Which of the following findings should the nurse report to the provider?
- A. Gastric pH of 2.5.
- B. Bowel sounds every 4 hours.
- C. Diarrhea of 250 mL in 24 hours.
- D. Gastric residual of 150 mL.
Correct answer: D
Rationale: A gastric residual of 150 mL may indicate delayed gastric emptying and should be reported to the provider.
2. A client is receiving morphine for pain management. Which of the following findings should the nurse report to the provider?
- A. Heart rate of 88/min
- B. Pain rating of 4 on a scale of 0 to 10
- C. Respiratory rate of 10/min
- D. Temperature of 37.2°C (99°F)
Correct answer: C
Rationale: A respiratory rate of 10/min indicates respiratory depression, a serious adverse effect of morphine that should be reported immediately. While a heart rate of 88/min, pain rating of 4, and a temperature of 37.2°C (99°F) are within normal ranges and do not indicate immediate concern related to morphine administration.
3. A client has a new prescription for spironolactone. Which of the following instructions should the nurse include?
- A. Take this medication with a potassium supplement.
- B. Avoid foods that contain potassium.
- C. Limit your fluid intake while taking this medication.
- D. Take this medication on an empty stomach.
Correct answer: B
Rationale: The correct answer is B because spironolactone is a potassium-sparing diuretic, which means it helps the body retain potassium. Instructing the client to avoid foods high in potassium helps prevent hyperkalemia, a potential side effect of spironolactone. Choice A is incorrect because taking spironolactone with a potassium supplement can increase the risk of hyperkalemia. Choice C is not directly related to spironolactone use. Choice D is also incorrect as spironolactone does not need to be taken on an empty stomach.
4. A nurse is caring for a client who is 2 hours postoperative following a thoracotomy. Which of the following findings should the nurse report to the provider?
- A. Chest tube drainage of 60 mL/hr
- B. Oxygen saturation of 95%
- C. Chest tube drainage of 120 mL/hr
- D. Heart rate of 88/min
Correct answer: C
Rationale: The correct answer is C. Chest tube drainage of more than 100 mL/hr may indicate active bleeding, which is a serious complication post-thoracotomy surgery. This finding should be reported to the healthcare provider immediately for further evaluation and intervention. Choices A, B, and D are within normal limits for a client 2 hours post-thoracotomy and do not require immediate reporting. Oxygen saturation of 95% is acceptable, and a heart rate of 88/min is within the normal range for an adult.
5. A nurse is caring for a client who is 3 days postoperative following a bowel resection. Which of the following findings should the nurse report to the provider?
- A. Heart rate of 80/min
- B. White blood cell count of 9,000/mm3
- C. Temperature of 37.8°C (100°F)
- D. Blood pressure of 118/78 mm Hg
Correct answer: C
Rationale: A temperature of 37.8°C (100°F) should be reported to the provider as it can indicate infection, a common postoperative complication. A normal heart rate of 80/min (Choice A), white blood cell count of 9,000/mm3 (Choice B), and blood pressure of 118/78 mm Hg (Choice D) are within normal ranges and do not necessarily indicate a complication postoperatively.
Similar Questions
Access More Features
ATI RN Basic
$69.99/ 30 days
- 5,000 Questions with answers
- All ATI courses Coverage
- 30 days access
ATI RN Premium
$149.99/ 90 days
- 5,000 Questions with answers
- All ATI courses Coverage
- 30 days access