ATI RN
ATI RN Fundamentals Updated 2023 Exam Questions
Extract:
Question 1 of 5
A nurse is caring for a client who is 2 days postoperative following bowel resection and reports sudden, severe abdominal pain. Which of the following actions should the nurse take first?
Correct Answer: D
Rationale: The correct answer is D: Expose the client's abdomen to look for changes in appearance. This action should be taken first because sudden, severe abdominal pain postoperatively can indicate a serious complication like internal bleeding or bowel perforation. By exposing the abdomen, the nurse can visually assess for signs of distention, discoloration, or any other abnormality that may indicate a surgical complication. This visual assessment can provide crucial information to guide further interventions.
Choices A, B, and C involve assessment techniques that may be important in evaluating the client's condition, but they should be secondary to visually inspecting the abdomen in this urgent situation.
Choice A focuses on bowel sounds, which may not be reliable in a postoperative client experiencing sudden severe pain.
Choice B involves palpation, which could potentially exacerbate any existing complications.
Choice C refers to assessing areas of resonance, which is less urgent compared to visually inspecting for immediate changes in the abdomen.
In summary, visually inspecting the client's
Question 2 of 5
A nurse is teaching a group of newly licensed nurses about the Braden scale. Which of the following responses by a newly licensed nurse indicates an understanding of the teaching?
Correct Answer: B
Rationale: The correct answer is B because the Braden scale measures six elements: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Each element is rated on a scale from 1 to 4, except for friction/shear, which is rated from 1 to 3. Understanding this key aspect of the Braden scale demonstrates a comprehensive knowledge of the tool.
Choice A is incorrect because each element is rated on a scale from 1 to 4 or 1 to 3, not 1 to 5.
Choice C is incorrect because the client's age is not a factor in the Braden scale measurement.
Choice D is incorrect because the higher the score on the Braden scale, the lower the pressure injury risk, not higher.
Question 3 of 5
A nurse is planning care for a client who is concerned about her tobacco smoking habits and is in the contemplation stage of health behavior change. Which of the following actions should the nurse plan to take during this stage?
Correct Answer: D
Rationale: The correct answer is D: Present information about the benefits of quitting smoking. During the contemplation stage, clients are considering the pros and cons of changing their behavior. Providing information about the benefits of quitting smoking can help the client make an informed decision. This action aligns with motivational interviewing techniques, which focus on exploring and resolving ambivalence towards behavior change. Recommending small changes (
A) may be more suitable for the preparation stage. Setting goals (
B) and developing a plan (
C) are actions typically taken during the action stage when the client is ready to make a change.
Question 4 of 5
A nurse is preparing to obtain informed consent from a client who speaks a different language than the nurse and is scheduled for surgery. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: The correct answer is B: Recommend an interpreter who is the same gender as the client. This is important for cultural sensitivity and to help the client feel more comfortable and at ease during the consent process. It ensures effective communication and understanding between the nurse, client, and interpreter. Using medical terminology (choice
A) may result in confusion for a client who does not speak the language. Addressing all questions to the interpreter (choice
C) may bypass direct communication with the client, leading to potential misunderstandings. Having the client nod to indicate understanding (choice
D) may not guarantee comprehension of the information.
Question 5 of 5
A charge nurse in a long-term care facility is preparing an educational program about delirium for newly hired nurses. Which of the following statements should the nurse plan to include?
Correct Answer: D
Rationale: The correct answer is D: Delirium has an abrupt onset. Delirium is characterized by a sudden and fluctuating change in mental status. This rapid onset is a key feature that distinguishes delirium from other cognitive disorders. Delirium can develop over hours to days and is often reversible when the underlying cause is identified and treated promptly.
A: Incorrect. Delirium can disrupt a client's sleep cycle, leading to disturbances like insomnia or excessive drowsiness.
B: Incorrect. Delirium can impact a client's perception of their environment, causing confusion, disorientation, and hallucinations.
C: Incorrect. Delirium typically has a rapid onset rather than a slow progression. It is important to recognize and address delirium promptly to prevent complications.