ATI RN
ATI Fundamental Proctored Exam Study Guide 2024-2025 Questions
Extract:
Question 1 of 5
A home health nurse is assessing the home for fire safety. Which information from the family will cause the nurse to intervene? (Select all that apply.)
Correct Answer: A, C, D
Rationale:
Correct Answer: A, C, D
Rationale:
A: Smoking in bed poses a high risk of starting a fire, as smoking materials can easily ignite bedding. Intervene to educate on safer habits.
C: Using an old space heater may be unsafe due to potential malfunctions or outdated safety features. Intervene to recommend a newer model.
D: Using the RACE method (Rescue, Alarm, Contain, Extinguish) is correct fire safety protocol. No intervention needed as this is a safe practice.
Summary:
B: Leaving candles unattended is a fire hazard, but the family states they never do this, so no intervention needed.
E: Having fire extinguishers in accessible locations is a good practice, so no intervention needed.
Overall, choices B and E demonstrate good fire safety practices, while choices A and C require intervention to address potential risks.
Question 2 of 5
A homeless adult patient presents to the emergency department with vital signs: temperature 94.8° F, blood pressure 106/56, apical pulse 58, and respiratory rate 12. Which vital sign should the nurse address immediately?
Correct Answer: B
Rationale: The nurse should address the temperature immediately. A temperature of 94.8°F is significantly below the normal range (around 98.6°F) and indicates hypothermia, which can be life-threatening. Hypothermia can lead to various complications, including altered mental status, cardiac arrhythmias, and even cardiac arrest.
Therefore, prompt intervention is crucial to prevent further deterioration. The other vital signs are within acceptable ranges for an adult, although the blood pressure is slightly low but not immediately critical like hypothermia. Addressing the temperature first is essential to stabilize the patient's condition and prevent potential complications.
Question 3 of 5
The nurse is assessing a patient for lead poisoning. Which patient is the nurse most likely assessing?
Correct Answer: B
Rationale: The correct answer is B:
Toddler.
Toddlers are most at risk for lead poisoning due to their tendency to explore and put objects in their mouths, including lead-contaminated items. Their developing bodies are more susceptible to the harmful effects of lead exposure. Young infants are less likely to be mobile and ingest lead. Preschoolers and adolescents are less at risk than toddlers due to their reduced likelihood of mouthing objects. Thus, the nurse is most likely assessing a toddler for lead poisoning.
Question 4 of 5
A confused patient is restless and continues to try to remove the oxygen cannula and urinary catheter. What is the priority nursing diagnosis and intervention to implement for this patient?
Correct Answer: A
Rationale: The correct answer is A: Risk for injury: Check on patient every 15 minutes. The priority nursing diagnosis in this scenario is addressing the patient's safety. By checking on the patient every 15 minutes, the nurse can monitor for any attempts to remove the oxygen cannula or urinary catheter, reducing the risk of injury. This intervention allows for timely detection and prevention of harm to the patient.
Choice B: Risk for suffocation: Placing an 'Oxygen in Use' sign on the door does not directly address the immediate safety concern of the patient attempting to remove the oxygen cannula.
Choice C: Disturbed body image: While addressing body image concerns is important, it is not the priority in this situation where the patient's immediate safety is at risk.
Choice D: Deficient knowledge: Explaining the purpose of oxygen therapy and the urinary catheter is important for patient education but does not address the urgent need to prevent injury in this case.
Question 5 of 5
The patient applies sequential compression devices after going to the bathroom. The nurse checks the patient's application of the devices and finds that they have been put on upside down. Which nursing diagnosis will the nurse add to the patient's plan of care?
Correct Answer: B
Rationale:
Correct Answer: B (Deficient knowledge)
Rationale:
1. The patient applying the sequential compression devices upside down indicates a lack of understanding (deficient knowledge) of how to use the devices correctly.
2. This nursing diagnosis focuses on the patient's lack of information or understanding, which can lead to incorrect implementation of interventions.
3.
Choices A, C, and D do not directly address the root cause of the issue, which is the patient's lack of knowledge about the proper use of the devices.
4. A risk for falls would be more appropriate if the patient were wearing slippery socks on a wet floor, not using compression devices incorrectly.
5. Risk for suffocation is not relevant to the scenario of upside-down compression devices.
6. Impaired physical mobility would be more applicable if the patient had difficulty moving or using the devices due to a physical limitation, not due to a lack of knowledge.