ATI RN
ATI Comprehensive 2024 Exit Exam with NGN Questions
Extract:
Question 1 of 5
A nurse is caring for a client who is immobile. Which of the following interventions is appropriate to prevent contracture?
Correct Answer: D
Rationale: The correct answer is D: Apply an orthotic to the client's foot. This intervention helps to maintain proper alignment of the foot, preventing contractures that can occur due to prolonged immobility. Placing a pillow under the client's knees (choice
A) is beneficial for reducing pressure on the lower back but does not specifically address foot contractures. Similarly, placing a towel roll under the client's neck (choice
B) is helpful for neck support but does not prevent foot contractures. Aligning a trochanter wedge between the client's legs (choice
C) is aimed at hip alignment and not foot contractures.
Therefore, the most appropriate intervention to prevent foot contractures in an immobile client is applying an orthotic to the client's foot.
Question 2 of 5
A nurse is assessing a client who is postoperative following abdominal surgery and has an indwelling urinary catheter that is draining dark yellow urine at 25 mL/hr. Which of the following interventions should the nurse anticipate?
Correct Answer: B
Rationale: The correct answer is B: Administer a fluid bolus. The dark yellow urine output at 25 mL/hr indicates concentrated urine and potential dehydration. Administering a fluid bolus would help improve hydration status and increase urine output. Continuous bladder irrigation (
A) is not indicated as there is no indication of bladder obstruction. Clamping the catheter tubing (
C) can lead to urinary retention and should not be done without a specific reason. Obtaining a urine specimen for culture (
D) is important, but addressing the dehydration issue takes priority.
Question 3 of 5
A nurse is reporting a client's laboratory tests to the provider to obtain a prescription for the cient's daily warfarin. Which of the following laboratory tests should the nurse plan to report to obtain the prescription for the warfarin?
Correct Answer: C
Rationale: The correct answer is C: INR. The International Normalized Ratio (INR) is used to monitor and adjust the dosage of warfarin, an anticoagulant medication. A nurse needs to report the INR level to the provider to determine if the current dosage of warfarin is effective in preventing blood clots. A higher INR indicates a longer time it takes for blood to clot, meaning the warfarin dosage might need adjustment.
Incorrect choices:
A: Fibrinogen level - Fibrinogen is a protein involved in blood clotting but is not specific for monitoring warfarin therapy.
B: aPTT - Activated Partial Thromboplastin Time (aPTT) is used to monitor heparin therapy, not warfarin.
D: Platelet count - Platelet count measures the number of platelets in the blood and is not directly related to warfarin therapy.
Overall, the INR is the most
Question 4 of 5
A nurse is assessing a client who is taking haloperidol and is experiencing pseudo parkinsonism. Which of the following findings should the nurse document as a manifestation of pseudo parkinsonism?
Correct Answer: B
Rationale: The correct answer is B: Shuffling gait. Pseudo parkinsonism is a common side effect of antipsychotic medications like haloperidol. A shuffling gait is a characteristic manifestation, which includes slow, shuffling, and stiff movements resembling those seen in Parkinson's disease. This occurs due to the blockade of dopamine receptors in the brain.
Choice A, serpentine limb movement, is not a typical manifestation of pseudo parkinsonism.
Choice C, nonreactive pupils, is more indicative of a possible neurological issue.
Choice D, smacking lips, is a manifestation of tardive dyskinesia, not pseudo parkinsonism.
Question 5 of 5
A nurse is caring for a client who is experiencing expressive aphasia and right hemiparesis following a stroke. Which of the following actions by the nurse best promotes communication among staff caring for the client?
Correct Answer: D
Rationale: Rationale for the Correct Answer (
D): Having interdisciplinary team meetings for the client on a regular basis is the best action to promote communication among staff caring for the client. This approach ensures that all healthcare team members are regularly updated on the client's condition, progress, and treatment plan. It allows for collaborative decision-making and coordination of care, leading to a holistic and effective approach to managing the client's needs. Additionally, it provides an opportunity for staff to discuss any challenges, share insights, and adjust interventions as needed to optimize the client's outcomes.
Summary of Incorrect
Choices:
A: Posting swallowing precautions at the head of the client's bed is important for safety but does not directly promote communication among staff.
B: Noting changes in the treatment plan in the client's medical record is essential for documentation but may not facilitate real-time communication among staff members.
C: Recording the client's progress in the nurses' notes is necessary for tracking the client's status but does not ensure comprehensive communication among all team