ATI RN
ATI Custom T1 PM Summer 2023 Exam 5 Questions
Extract:
Question 1 of 5
A nurse calculates a client's fluid intake over the past 8 hours. The client had one 4-oz cup of coffee, 3 oz of juice, and 12 oz of soda. How many mL should the nurse document as the client's total intake for the shift?
Correct Answer: C
Rationale: The correct answer is C: 570 mL.
To calculate the total intake, convert the volume of each drink to mL: 4 oz = 120 mL, 3 oz = 90 mL, 12 oz = 360 mL. Add these together: 120 + 90 + 360 = 570 mL. This is the total fluid intake for the client over the past 8 hours.
Choice A (120 mL) is incorrect as it only accounts for the coffee.
Choice B (90 mL) is incorrect as it only accounts for the juice.
Choice D (360 mL) is incorrect as it only accounts for the soda.
Question 2 of 5
A nurse is caring for a client who has an oxygen saturation of 88%. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: The correct answer is C: Encourage the client to take deep breaths. This action will help improve oxygenation by increasing lung ventilation and oxygen exchange. Deep breathing helps to expand the lungs fully, allowing more oxygen to enter the bloodstream. Decreasing the head of the bed (
A) is typically done for clients with respiratory distress to improve oxygenation. Asking the client to cough (
B) every 4 hours may help with airway clearance but does not directly address oxygen saturation. Requesting an opioid analgesic (
D) is not indicated for improving oxygen saturation and may potentially depress the respiratory drive, worsening the situation.
Question 3 of 5
A nurse is caring for a client who has a new diagnosis of diabetes mellitus. The client states they will never be able to follow the prescribed diet. Which of the following statements should the nurse make?
Correct Answer: B
Rationale: The correct answer is B: "Let's see what foods you like that we can include in your new diet." This response demonstrates client-centered care by involving the client in the decision-making process. By identifying foods the client likes, the nurse can tailor the diet plan to be more acceptable and achievable for the client, increasing the likelihood of adherence. This approach empowers the client and promotes a positive relationship between the client and the healthcare provider.
Other choices are incorrect:
A: "Most people get used to the new diet quickly." This statement generalizes and may not address the client's specific concerns or barriers to dietary changes.
C: "You will feel better once you start the new diet." This statement assumes the client's feelings without acknowledging their current concerns.
D: "Your old diet probably caused your diabetes." Blaming the client's previous diet may induce guilt or shame, hindering the client's motivation to make positive changes.
Question 4 of 5
A nurse is caring for a client who reports back pain. The nurse asks the client to rate the pain on a scale of 0 to 10. The nurse is using which of the following to assess the pain?
Correct Answer: A
Rationale: The correct answer is A: Severity. By asking the client to rate the pain on a scale of 0 to 10, the nurse is assessing the severity of the pain. This helps the nurse understand the intensity of the pain the client is experiencing, which is crucial for determining appropriate interventions. Assessing the severity of pain is a fundamental aspect of pain assessment. Other choices are incorrect because: B (Quality) focuses on the characteristics of the pain, C (Region) identifies the location of the pain, and D (Precipitating cause) seeks to determine what triggers the pain. These options are important aspects of pain assessment but do not directly address the intensity or severity of the pain, making them less relevant in this context.
Question 5 of 5
Which of the following findings is a subjective indicator of pain?
Correct Answer: A
Rationale: The correct answer is A: The client reports a burning sensation. This is a subjective indicator of pain because it is based on the client's personal experience and self-report. Pain is a subjective experience that can vary greatly among individuals, so the client's own description of their pain is the most reliable indicator.
Incorrect choices:
B: The client's pupils are dilated - This is a physiological response and not a direct indicator of pain.
C: The client is grimacing - While grimacing can be a sign of pain, it is still an observable behavior and not a direct indicator provided by the client.
D: The client is restless - Restlessness can indicate discomfort but is not specific to pain and can have various causes.