ATI RN
ATI RN Fundamentals Exam 6 Questions
Extract:
Question 1 of 5
A nurse is assessing a client's lower extremities and notes 6 mm pitting edema. Which of the following is appropriate documentation of this assessment finding?
Correct Answer: C
Rationale: 1+ pitting edema is mild with a slight indentation. 4+ pitting edema is severe with a deep indentation that lasts a long time. 3+ pitting edema is moderate with a deeper indentation that takes some time to rebound. 2+ pitting edema is moderate with a slight indentation that rebounds fairly quickly.
Question 2 of 5
The parent of a toddler is concerned that his child has suddenly become disinterested in certain foods. Which of the following statements is the appropriate response by the nurse?
Correct Answer: C
Rationale: Encouraging feeding anything the child will eat might lead to poor nutrition. It's important to ensure a balanced diet. Acknowledging the concern is valid but the nurse should provide guidance rather than just expressing concern. This response acknowledges the concern but reassures the parent that if the child appears healthy no immediate intervention is necessary promoting a balanced approach. Increasing calories and water without a specific reason or assessment may not address the underlying issue and is not the initial recommended intervention.
Question 3 of 5
A 5-year-old client is refusing to let the nurse take his blood pressure. To promote cooperation the nurse should:
Correct Answer: C
Rationale: Telling the child that it will not hurt may not be effective as children may still have anxiety or fear related to the unknown. Forcing a child or having the parent hold tightly may increase anxiety and make the child more resistant to the procedure. Allowing the child to operate the equipment can give the child a sense of control and involvement increasing cooperation. Deferring the procedure until the next visit may not be practical or necessary if alternative strategies can be employed to promote cooperation.
Question 4 of 5
A nurse is caring for a client who has a dysrhythmia. Which of the following techniques is appropriate for the nurse to use to assess for a pulse deficit?
Correct Answer: A
Rationale: Obtaining apical and radial rates simultaneously allows the nurse to assess for a pulse deficit by comparing the two rates. A pulse deficit is present when the apical rate (heard with a stethoscope) is greater than the radial rate (palpated at the wrist). Palpating pulses in the lower extremities is not specific for assessing a pulse deficit and may not accurately reflect the cardiac output. Checking blood pressure in left and right arms assesses for blood pressure differences but does not specifically address a pulse deficit. Comparing the pulse strength in the upper extremities does not directly assess for a pulse deficit; simultaneous assessment of apical and radial rates is more appropriate.
Question 5 of 5
A nurse is evaluating a client's use of crutches. Which of the following observations indicates safe use of this equipment?
Correct Answer: D
Rationale: Placing one crutch on each side when assuming a sitting position is not the correct technique. The client should use both crutches on one side to provide support when sitting or rising. Placing weight on the axillae when walking can cause nerve damage and is an incorrect crutch-walking technique. The client should bear weight on the hands and arms not the axillae. Moving the unaffected leg onto a step first when descending stairs is a correct and safe technique for using crutches on stairs. Having slightly flexed elbows when ambulating with crutches is a proper technique for maintaining balance and support while walking.