ATI RN
ATI Fundamentals 2023 Retake Questions
Extract:
Question 1 of 5
A home health nurse is caring for a client who has a chronic illness and recently moved in with their adult child. Which of the following statements by the client should indicate to the nurse that the client has adapted to their new situational role?
Correct Answer: A
Rationale:
Rationale:
Choice A indicates the client has adapted to their new role by expressing appreciation for having others cook, showing acceptance of receiving care.
Choice B suggests confusion and lack of purpose, indicating difficulty adjusting.
Choice C reflects a desire for independence, not necessarily adaptation to the new role.
Choice D implies reluctance to ask for help, which may hinder adaptation. Overall, choice A demonstrates a positive attitude towards the new living situation, making it the correct answer.
Question 2 of 5
A nurse is preparing to administer a medication to a client for the first time. Which of the following actions should the nurse take to help ensure safe medication administration?
Correct Answer: D
Rationale: The correct answer is D: Access the online drug formulary for an unfamiliar medication. This is important to ensure safe medication administration as it allows the nurse to verify the medication's indications, contraindications, dosages, and potential side effects. By accessing the drug formulary, the nurse can gather essential information to make informed decisions and prevent medication errors. Reading the medication label twice (
A) may help ensure accuracy but does not provide comprehensive information. Using one patient identifier (
B) is essential for patient safety but does not specifically address medication administration. Asking the client about similar medications (
C) may be helpful but does not provide objective and detailed information.
Question 3 of 5
A nurse is assessing a client who has cirrhosis. Which of the following findings indicates the client is experiencing a fluid volume excess?
Correct Answer: A
Rationale:
Correct Answer: A (Dependent edema)
Rationale: In cirrhosis, liver dysfunction impairs albumin synthesis, leading to decreased plasma oncotic pressure and fluid shifting into the interstitial spaces, causing dependent edema. This is a classic sign of fluid volume excess.
Summary of Incorrect
Choices:
B (Increased serum sodium): Fluid volume excess typically leads to dilutional hyponatremia, not increased serum sodium.
C (Thready pulse): Thready pulse may indicate decreased cardiac output but is not specific to fluid volume excess.
D (Increased thirst): Increased thirst is more indicative of fluid volume deficit, not excess.
Question 4 of 5
A nurse is assessing a client who is receiving a blood transfusion. The nurse notes lung crackles, hypoxia, and distended neck veins. Which of the following actions should the nurse take? (Select all that apply.)
Correct Answer: A,B,D,E
Rationale:
Correct Answer: A, B, D, E
Rationale:
A: Obtain a prescription for a diuretic - Lung crackles and distended neck veins indicate fluid overload, so a diuretic can help to reduce fluid volume.
B: Administer oxygen to the client - Hypoxia indicates inadequate oxygenation, so administering oxygen is crucial to improve oxygen levels.
D: Stop the transfusion - These signs suggest a transfusion reaction, so stopping the transfusion is essential to prevent further harm.
E: Place the client in high-Fowler's position - Elevating the client's head can help improve breathing and oxygenation by reducing pressure on the lungs.
Summary of Incorrect
Choices:
C: Administer epinephrine to the client - Epinephrine is not indicated for fluid overload or transfusion reaction symptoms.
F: No information provided.
G: No information provided.
Question 5 of 5
A nurse is preparing to administer several medications via an NG tube to a client who is receiving a continuous tube feeding. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Flush the NG tube with 5 mL of sterile water for irrigation prior to administration. This action is important to ensure that the NG tube is clear and free of any residual formula or medication, preventing potential clogs or interactions. Flushing the tube with sterile water helps maintain the tube's patency and prevents any obstruction.
Summary of incorrect choices:
B: Mixing medications together in a single syringe can lead to drug interactions and inconsistent dosing.
C: Combining medications with the formula in the feeding bag can alter the medication's effectiveness and may lead to clogs in the tube.
D: Diluting each crushed medication with warm water may not effectively clear the tube and could still lead to clogs or interactions.