ATI RN
RN ATI FUNDAMENTALS 2024 EXAM Questions
Extract:
Nurses’ Notes 1000: Client admitted with a productive cough with thick yellow sputum. Breath sounds with crackies heard n left upper lobe and decraased braath sounds at bases bilaterally. 0 Heartate
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Question 1 of 5
A nurse is caring for 3 clients who have COPD. Select the 3 findings that require follow-up. Nurses' Notes: Temperature 100°F, oxygen saturation 88%, blood pressure 130/80 mmHg. Client admitted with a productive cough with thick yellow sputum. Breath sounds with crackles heard in the left upper lobe and decreased breath sounds at bases bilaterally. Heart rate 98 beats/min.
Correct Answer: A, B, D
Rationale: The correct answers are A, B, and D. A temperature of 100°F indicates possible infection or inflammation, requiring follow-up. Oxygen saturation of 88% is below the normal range (95-100%), indicating hypoxemia. A heart rate of 98 beats/min is elevated, possibly due to hypoxemia or increased work of breathing. Blood pressure of 130/80 mmHg is within normal limits. Crackles in the left upper lobe and decreased breath sounds suggest lung pathology but do not require immediate follow-up.
Extract:
Question 2 of 5
A nurse is talking with the partner of a client who has dementia. The client's partner expresses frustration about finding time to manage household responsibilities while caring for their partner. The nurse should identify that the partner is experiencing which of the following types of role-performance stress?
Correct Answer: C
Rationale: The correct answer is C: Role overload. This is because the partner is feeling overwhelmed with managing household responsibilities alongside caring for their partner with dementia, indicating an excessive amount of roles to fulfill. Role overload occurs when an individual is faced with too many responsibilities and not enough time or resources to fulfill them all effectively.
A: Role ambiguity refers to uncertainty about one's responsibilities or expectations in a role, which is not the case in this scenario.
B: Sick role is when an individual takes on the identity of being sick and may rely on others for help, which does not align with the partner's situation.
D: Role conflict is when there are conflicting demands between different roles, which is not the primary issue here.
In summary, the partner is experiencing role overload because they are struggling to balance multiple responsibilities, leading to feelings of frustration and stress.
Question 3 of 5
A nurse in a long-term care facility is caring for a client who dies during the nurse's shift. Identify the sequence in which the nurse should perform the following steps. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)
Correct Answer: B, E, C, D, A
Rationale: Correct Order: B, E, C, D, A
Rationale:
1. Obtain the pronouncement of death from the provider (
B) is the first step to officially declare the client deceased.
2. Ask the client's family members if they would like to view the body (E) to involve them in the process and offer closure.
3. Remove tubes and indwelling lines (
C) to ensure the body is prepared for further care.
4. Wash the client's body (
D) as part of maintaining dignity and respect for the deceased.
5. Place a name tag on the body (
A) for identification purposes.
Summary:
- F and G are missing steps and do not contribute to the immediate post-death care.
- Choosing A first may not be appropriate until the body is ready for identification.
- Other steps like notifying authorities or documenting events are not included in the given choices.
Question 4 of 5
A nurse is caring for a client who has a terminal illness and is approaching death. The client is short of breath and has noisy respirations from secretions in their airway. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: The correct answer is B: Administer an anti-cholinergic medication. This medication helps reduce respiratory secretions, making breathing easier for the client. Turning the client every 2 hours (choice
A) is important for preventing bedsores but does not address the immediate respiratory distress. Holding oral care (choice
C) can worsen the secretions. Increasing room temperature (choice
D) does not address the respiratory issue. Other choices are not provided, but administering an anti-cholinergic is the priority to provide comfort and ease breathing for the client in this situation.
Question 5 of 5
A nurse is caring for a client who is postoperative and refuses to use an incentive spirometer following major abdominal surgery. Which of the following actions is the nurse's priority?
Correct Answer: B
Rationale: The correct answer is B. The nurse's priority is to determine the reasons why the client is refusing to use the incentive spirometer. By understanding the client's concerns or fears, the nurse can address them effectively. This approach promotes client-centered care and helps in creating a supportive environment for the client's recovery. Requesting a respiratory therapist (choice
A) is not the priority as the client's refusal needs to be addressed first. Documenting the client's refusal (choice
C) is important but does not address the underlying issue. Administering pain medication (choice
D) is not the priority as it does not address the client's refusal.