ATI RN
RN-ATI-Fundamentals-of-Nursing-2023-2024 Questions
Extract:
Question 1 of 5
A nurse is assisting with the care of a client who has a prescription for IV therapy. The client tells the nurse that he has numerous allergies. Which of the following allergies should the nurse bring to the attention of the charge nurse prior to the initiation of the therapy?
Correct Answer: A
Rationale:
Correct
Answer: A (Latex)
Rationale: Latex allergies can lead to severe reactions, including anaphylaxis, if the client comes into contact with latex during IV therapy. It is crucial to inform the charge nurse to ensure alternative materials are used to prevent a life-threatening allergic reaction.
Summary of other choices:
B: Seafood - While seafood allergies are common, they are not directly related to IV therapy unless the IV solution contains seafood-derived components.
C: Bee stings - Bee sting allergies are important but are not directly relevant to IV therapy unless there is a risk of exposure during the procedure.
D: Peanuts - Peanut allergies are significant but do not pose a direct threat during IV therapy unless peanuts are present in the IV solution or equipment.
Question 2 of 5
A nurse is reinforcing teaching with a client who has hypertension and a prescription to measure her blood pressure daily. Which of the following client statements indicates an understanding of the teaching?
Correct Answer: C
Rationale: The correct answer is C because removing constrictive clothing prior to measuring blood pressure helps ensure accurate readings. Tight clothing can artificially elevate blood pressure readings.
Choice A is incorrect because waiting 15 minutes after drinking coffee doesn't impact blood pressure measurement accuracy.
Choice B is incorrect because the arm should be at heart level, not elevated.
Choice D is incorrect because blood pressure should be measured on an empty stomach for consistency.
Question 3 of 5
A nurse is setting up a sterile field to perform wound irrigation for a client. Which of the following actions should the nurse take when pouring the sterile solution?
Correct Answer: A
Rationale: The correct answer is A because when setting up a sterile field, it is essential to maintain sterility. By removing the cap and placing it sterile-side up on a clean surface, the nurse ensures that the inside of the cap, which will come in contact with the solution, remains sterile. Placing the cap sterile-side up prevents contamination and maintains the integrity of the sterile field.
Choices B, C, and D are incorrect. Placing sterile gauze over spilled solution does not address the primary concern of maintaining sterility. Holding the bottle in the center of the sterile field or with the label facing away from the palm does not directly impact the sterility of the solution.
Therefore, they are not the best actions to take when pouring the sterile solution during wound irrigation.
Question 4 of 5
A nurse is caring for a client who has acute glomerulonephritis. Which of the following findings should the nurse expect?
Correct Answer: D
Rationale: The correct answer is D: Hematuria. In acute glomerulonephritis, there is inflammation of the glomeruli in the kidneys, leading to blood in the urine. This is due to damage to the glomerular capillaries allowing red blood cells to leak into the urine. Oliguria (
A) is not a common finding as there is usually normal to increased urine output. Hypotension (
B) is not typically seen as glomerulonephritis can lead to fluid overload and hypertension. Weight loss (
C) is unlikely as fluid retention is common. Hematuria (
D) is the hallmark finding due to the damage to glomeruli.
Question 5 of 5
A nurse is caring for a client who is expressing anger about his diagnosis of colorectal cancer. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Reassure the client that this is an expected response to grief. This is the correct action as it validates the client's feelings and provides reassurance that anger is a common emotion when dealing with a cancer diagnosis. By acknowledging the client's emotions, the nurse can build trust and support the client through the grieving process.
A: Discussing risk factors is not the priority when the client is expressing anger.
B: Focusing on future management may be overwhelming for the client at this stage.
C: Providing written information about loss and grief phases may not address the client's current emotional state.
In summary, option D is the best choice as it acknowledges the client's feelings and offers support during a difficult time.