ATI RN
ATI RN Fundamentals 2023 Questions
Extract:
Question 1 of 5
A nurse is caring for a client who has dysphagia. When assisting the client during breakfast, which of the following actions by the client indicates the nurse should intervene?
Correct Answer: A
Rationale: The correct answer is A because using a straw with thickened juice can increase the risk of aspiration for a client with dysphagia. Straws can bypass the natural swallowing process, leading to potential choking or aspiration. Option B is correct as it promotes proper positioning for swallowing. Option C is incorrect as taking breaks during meals is common for clients with dysphagia to prevent fatigue. Option D is also correct as tucking the chin helps to protect the airway during swallowing.
Question 2 of 5
A nurse is caring for a client who had a stroke and coughs frequently when swallowing. The nurse should request a referral to which of the following members of the interdisciplinary team?
Correct Answer: A
Rationale: The correct answer is A: Speech-language pathologist. This professional specializes in evaluating and treating swallowing difficulties, known as dysphagia, which is common after a stroke. The speech-language pathologist can assess the client's swallowing function, provide strategies to improve safety during meals, and recommend appropriate diet modifications. The other choices, such as social worker, physical therapist, and occupational therapist, do not have the specific expertise in managing swallowing disorders like a speech-language pathologist does in this scenario.
Question 3 of 5
A nurse is preparing to provide postmortem care for a client. Which of the following actions should the nurse plan to take?
Correct Answer: B
Rationale: The correct answer is B: Ask the family if they wish to assist in washing the client's body. This action is important as it involves the family in the care of their loved one, allowing them to participate in the process and find closure. It also respects cultural and religious beliefs related to death rituals.
Choice A is incorrect because turning the overhead lights to a bright setting may not be appropriate for a sensitive and respectful environment during postmortem care.
Choice C is incorrect because removing the client's dentures without the family's consent may cause distress or be against their wishes.
Choice D is incorrect because leaving the client's eyes open until the family views the body may not be culturally or emotionally appropriate for the family and may cause unnecessary discomfort.
Question 4 of 5
A nurse is teaching a client how to self-administer heparin. Which of the following instructions should the nurse include in the teaching?
Correct Answer: C
Rationale: The correct answer is C: Inject 5.1 cm (2 in) away from the umbilicus. This instruction is important to prevent any damage to the abdominal organs near the umbilicus. Injecting heparin too close to the umbilicus can lead to injury or bleeding.
Choice A is incorrect because an 18-gauge, 1-inch needle is too large for subcutaneous injections like heparin administration.
Choice B is incorrect as massaging the injection site after withdrawing the needle can increase the risk of bruising or bleeding.
Choice D is incorrect as expelling air bubbles before injecting medication is essential for intravenous injections, not subcutaneous injections like heparin.
Question 5 of 5
A nurse is preparing to administer packed RBCs to a client who has a low hemoglobin level. Which of the following actions should the nurse take prior to the start of the infusion?
Correct Answer: D
Rationale: The correct answer is D: Check the blood product's compatibility with the client's blood type. This step is crucial to prevent a transfusion reaction, as administering incompatible blood can be life-threatening. The nurse should verify the blood product against the client's blood type and Rh factor to ensure compatibility.
A: Priming the IV tubing with lactated Ringer's is not necessary before administering packed RBCs and does not ensure the blood product's compatibility.
B: Confirming the client's identity with the blood bank technician is important but does not directly relate to ensuring the blood product's compatibility.
C: Checking for a small gauge IV catheter is important for infusion, but it is not directly related to ensuring the blood product's compatibility.
Overall, the priority before administering packed RBCs is to confirm compatibility with the client's blood type to prevent adverse reactions.