ATI RN
ATI Exit Exam RN
1. How should a healthcare professional monitor a patient for infection post-surgery?
- A. Monitor the surgical site
- B. Monitor for fever
- C. Check blood pressure
- D. Check for redness
Correct answer: A
Rationale: Monitoring the surgical site is crucial to identify early signs of infection post-surgery. Redness, swelling, warmth, or discharge at the surgical site can indicate an infection. While monitoring for fever (choice B) is important as fever can also be a sign of infection, it may not always present immediately post-surgery. Checking blood pressure (choice C) is essential for other purposes but not specifically for monitoring infection post-surgery. Checking for redness (choice D) is limited as redness alone may not always indicate an infection, so it is not as comprehensive as monitoring the surgical site.
2. A nurse is caring for a client who has a prescription for a low-sodium diet. Which of the following foods should the nurse recommend?
- A. Pickles
- B. Fresh vegetables
- C. Canned soup
- D. Smoked salmon
Correct answer: B
Rationale: Fresh vegetables are an excellent choice for clients on a low-sodium diet as they are naturally low in sodium. Pickles, canned soup, and smoked salmon are high in sodium and should be avoided by clients following a low-sodium diet. Pickles are pickled in a brine solution high in sodium, canned soup usually contains added salt for preservation, and smoked salmon is a processed food that typically has a high sodium content.
3. A client with heart failure is being educated by a nurse about fluid restrictions. Which of the following instructions should the nurse include?
- A. Limit your fluid intake to 3 liters per day.
- B. Increase your fluid intake to 5 liters per day.
- C. Avoid drinking more than 1 liter of fluid per day.
- D. You can drink as much fluid as you want during meals.
Correct answer: C
Rationale: The correct answer is C: "Avoid drinking more than 1 liter of fluid per day." Clients with heart failure are typically advised to limit their fluid intake to around 1 liter per day to prevent fluid overload, which can worsen their condition. Choices A, B, and D are incorrect because they suggest fluid intakes that are higher than the recommended limit, which could lead to fluid retention and exacerbate heart failure symptoms.
4. A nurse is caring for a client who has chronic obstructive pulmonary disease (COPD) and is experiencing dyspnea. Which of the following actions should the nurse take?
- A. Encourage the client to take deep breaths.
- B. Place the client in a high-Fowler's position.
- C. Administer a bronchodilator.
- D. Administer oxygen at 6 L/min via face mask.
Correct answer: B
Rationale: The correct answer is to place the client in a high-Fowler's position. This position helps improve breathing by expanding the lungs and aiding in better oxygenation. Encouraging the client to take deep breaths may not be effective in managing dyspnea in COPD as it can lead to fatigue. Administering a bronchodilator may be necessary but placing the client in a high-Fowler's position should be the priority. Administering oxygen at 6 L/min via face mask may also be needed, but positioning is the initial intervention to optimize respiratory function.
5. A nurse is caring for a client with heart failure receiving digoxin. Which of the following findings should the nurse report to the provider?
- A. Heart rate 60/min.
- B. Blood pressure 110/70 mm Hg.
- C. Serum potassium 4 mEq/L.
- D. Blood pressure 120/80 mm Hg.
Correct answer: B
Rationale: The correct answer is B. A blood pressure of 110/70 mm Hg is a finding that the nurse should report to the provider when caring for a client with heart failure receiving digoxin. Digoxin can cause hypotension, so a low blood pressure reading should be reported promptly to the provider for further evaluation and management. Choices A, C, and D are within normal ranges and would not require immediate reporting. A heart rate of 60/min is considered normal, but any further decrease should be monitored. A serum potassium level of 4 mEq/L is also within the normal range. A blood pressure of 120/80 mm Hg is typically considered normal as well.
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