ATI RN
ATI Leadership 2023 I Questions
Question 1 of 5
A nurse is assessing pressure ulcers on four clients to evaluate the effectiveness of a change in wound care procedure. Which of the following findings indicates wound healing?
Correct Answer: B
Rationale: The correct answer is B: Deep red color on the center of a client's wound. This finding indicates wound healing as it suggests the formation of granulation tissue, which is essential for the wound healing process. Granulation tissue is rich in blood vessels and appears deep red in color. This indicates that the wound is in the proliferative phase of healing.
Choice A - Erythema on the skin surrounding a client's wound - Erythema typically indicates inflammation and is not a clear sign of wound healing.
Choice C - Increase in serosanguineous exudate from a client's wound - Increased exudate may indicate inflammation or infection, not necessarily healing.
Choice D - Inflammation noted on the tissue edges of a client's wound - Inflammation suggests the wound is still in the inflammatory phase of healing, not the proliferative phase where granulation tissue forms.
Question 2 of 5
A hospice nurse is caring for a client who has a terminal illness and reports severe pain. After the nurse administers the prescribed opioid and benzodiazepine, the client becomes somnolent and difficult to arouse. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Withhold the benzodiazepine but continue the opioid. Benzodiazepines can potentiate the sedative effects of opioids, leading to increased somnolence and difficulty arousing the client. By withholding the benzodiazepine, the nurse can help decrease the sedative effects, allowing the client to become more responsive while still receiving pain relief from the opioid. Continuing the opioid ensures that the client's pain is adequately managed. Administering the benzodiazepine alone (choice
B) may exacerbate the sedative effects. Continuing the medication dosages (choice
C) without adjusting the benzodiazepine dose may not address the sedation issue. Contacting the provider about replacing the opioid with an NSAID (choice
D) is not indicated as opioids are typically the mainstay for managing severe pain in terminal illness.
Question 3 of 5
A nurse is caring for a client who is having difficulty walking following a stroke. For which of the following members of the interprofessional team should the nurse request a referral?
Correct Answer: D
Rationale: The correct answer is D: Physical therapist. The physical therapist specializes in helping individuals regain mobility and strength after a stroke, making them the most appropriate professional to address the client's difficulty walking. They will develop a personalized exercise program to improve balance and coordination. Referring to the other options would not directly address the client's physical mobility issues. Occupational therapists focus on daily living activities, social workers on emotional and social support, and dietitians on nutritional needs, none of which directly address the client's walking difficulty.
Question 4 of 5
A charge nurse notices that two staff nurses are not taking meal breaks during their shifts. Which of the following actions should the nurse take first?
Correct Answer: A
Rationale: Determining the reasons for not taking breaks identifies the root cause, enabling targeted solutions to ensure staff well-being.
Question 5 of 5
A nurse on a surgical unit is preparing to transfer a client to a rehabilitation facility. Which of the following information should the nurse include in the change-of-shift report?
Correct Answer: C
Rationale: The correct answer is C: The time the client received his last dose of pain medication. This information is crucial for ensuring continuity of care and preventing medication errors. It helps the rehabilitation facility staff know when the next dose is due and if any additional pain relief is needed.
A: The client's preferred time for bathing is important for comfort but not as critical as pain medication timing in a transfer report.
B: The belief about the client's relationship with his son is not relevant to the client's immediate care needs during transfer.
D: The steps for wound care are important but should be included in a separate document or care plan, not necessarily in a brief change-of-shift report.