ATI RN
RN ATI FUNDAMENTALS 2024 EXAM Questions
Extract:
Question 1 of 5
A nurse is assessing an older adult client's risk for falls. Which of the following assessments should the nurse use to identify the client's safety needs? (Select all that apply)
Correct Answer: D,E
Rationale: The correct assessments for identifying an older adult client's safety needs are visual fields (
D) and visual acuity (E). Visual impairment is a significant risk factor for falls in the elderly. Visual fields assess peripheral vision, crucial for detecting obstacles, while visual acuity assesses central vision, important for spatial awareness. Lacrimal apparatus (
A), pupil clarity (
B), and appearance of bulbar conjunctivae (
C) do not directly assess visual function or fall risk in this context.
Question 2 of 5
A nurse in a provider's office is assessing the deep tendon reflexes of a client. Which of the following images should the nurse identify as indicating the correct technique for eliciting the client's patellar reflex?
Correct Answer: A
Rationale: The correct answer is A. The nurse should identify this image as indicating the correct technique for eliciting the client's patellar reflex because the client is sitting with legs dangling over the edge of the table, which allows the quadriceps muscle to be in a slightly stretched position. The examiner is tapping below the patella with a reflex hammer, directly stimulating the patellar tendon to elicit the reflex. This position and technique are essential for a proper response, as it activates the muscle spindle fibers to trigger the reflex arc involving the sensory and motor neurons.
Choices B, C, and D are incorrect because they do not follow the correct technique for eliciting the patellar reflex. In choice B, tapping above the patella would not directly stimulate the patellar tendon. In choice C, having the client's legs crossed would not allow for proper muscle tension required for the reflex. In choice D, having the client standing with knees slightly bent may not provide the necessary muscle tension or positioning for an accurate
Extract:
Vital signs:Temperature 36.2° C (97.2° F) Pulse rate 116/min Respiratory rate 24/min BP 102/68 mm Hg Oxygen saturation 95% Weight 52.2 kg (115 Ib
Question 3 of 5
A nurse in a provider's clinic is caring for a client who has diarrhea. The nurse is providing teaching for the client. Select the 4 instructions the nurse should include in the teaching.
Correct Answer: B, C, F, G
Rationale: The correct instructions are B, C, F, and G. Probiotic foods like yogurt can help restore gut flora. Avoiding alcohol and caffeine is important as they can worsen diarrhea. Drinking lots of fluids is crucial to prevent dehydration. High-calcium foods (
A) are not directly related to managing diarrhea. Eating raw vegetables (
D) may be hard to digest. Eating three large meals a day (E) may be too heavy on the digestive system.
Extract:
Question 4 of 5
A nurse is evaluating a client's use of a cane. Which of the following actions should the nurse identify as an indication of correct use?
Correct Answer: D
Rationale: The correct answer is D: The client holds the cane on the stronger side of her body. This is correct because when using a cane, it should be held on the stronger side to provide support and stability. Placing the cane on the stronger side helps to offload weight from the weaker side, reducing the risk of falls.
Choice A is incorrect because the top of the cane should ideally be at the level of the greater trochanter, not necessarily parallel to the wrist.
Choice B is vague and does not indicate correct use.
Choice C is incorrect as there is no specific measurement for how far the cane should be moved forward.
Choice E is incorrect as the client should move the weaker limb forward with the cane for support.
Extract:
Nurses’ Notes
First Clinic Vist:
Cliet arrives to dinc with report of increasing shortness of breath, fatigue. and weakness. States they gt short of breath with minimal activiy.
Cllent s alert and oriented to person, pace, and time. Maoves allextremities well, follows simple commands. Sinus tachycardia, Pulses to lowr extremitis wesk with +2 dependent edema present,
Slightlylabored respirations at rst. Chest with wheezes and crackles n the basas. Reports productive cough, especially during the overnight hours.
Bowel sounds al presen. Abdomen distended. Reports bowel movement this am.
States voiding without dfficulty, lear yellow urine
Teaching provided on nuition therapy and adhering to & ow-sodium diet, monitoring fud intake, and Ifestyle changes for heart fallure. Provided medication teaching following provider's increase in furosemide dosage
Question 5 of 5
A nurse is assessing a client with heart failure. The client reports increasing shortness of breath, fatigue, and weakness. Which of the following findings in the assessment should the nurse identify as most concerning?
Correct Answer: C
Rationale: The correct answer is C: Wheezes and crackles in the chest. This finding is most concerning in a client with heart failure because it indicates potential fluid buildup in the lungs, known as pulmonary edema, which can lead to severe respiratory distress and compromise oxygenation. Wheezes suggest bronchoconstriction, while crackles indicate fluid in the alveoli. These signs are indicative of worsening heart failure and require immediate intervention.
Weak pulses with +2 dependent edema in lower extremities (
Choice
A) are expected findings in heart failure due to fluid retention, but they do not directly indicate acute respiratory compromise. Slightly labored respirations at rest (
Choice
B) may be common in heart failure, but they are not as concerning as the presence of wheezes and crackles. Reports of productive cough during overnight hours (
Choice
D) may suggest underlying respiratory infection but are not as urgent as the respiratory distress indicated by wheezes and crackles.