ATI RN
ATI Comprehensive 2024 Exit Exam with NGN Questions
Extract:
Question 1 of 5
A nurse is caring for a client who requires seclusion to prevent harm to others on the unit. Which of the following is an appropriate action for the nurse to take?
Correct Answer: A
Rationale: The correct answer is A: Document the client's behavior prior to being placed in seclusion. This is important for legal and clinical reasons as it provides a clear record of the client's behavior leading up to seclusion, ensuring transparency and accountability. Assessing behavior once every hour (choice
B) may not be sufficient for monitoring the client's condition in seclusion. Offering fluids every 2 hours (choice
C) is important for hydration but not directly related to seclusion. Discussing inappropriate behavior with the client (choice
D) may escalate the situation and is not recommended in this scenario.
Question 2 of 5
A nurse is caring for an adolescent who has hyperthermia. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Initiate seizure precautions. Hyperthermia can lead to seizures due to the brain's sensitivity to high temperatures. Seizure precautions involve ensuring a safe environment, padding the bed, and having emergency equipment ready. Administering oral acetaminophen (
A) is not the priority in hyperthermia as it may not rapidly reduce the temperature. Covering with a thermal blanket (
B) may further increase body temperature. Submerging feet in ice water (
C) can cause vasoconstriction and shivering, leading to increased core temperature.
Question 3 of 5
A nurse is caring for a client who asks for information regarding organ donation. Which of the following responses should the nurse make?
Correct Answer: C
Rationale: The correct response should be C: "Your desire to be an organ donor must be documented in writing." This is the correct answer because in order for someone to become an organ donor, their decision must be documented in writing, typically through an organ donor card, a driver's license designation, or registration with a national organ donation registry. This documentation is crucial to ensure that the individual's wishes are respected and followed in the event of their death.
The other choices are incorrect:
A: "I cannot be a witness for your consent to donate." This statement is incorrect as a nurse can provide information and support regarding organ donation, but they are not required to be a witness for consent.
B: "You must be at least 21 years of age to become an organ donor." This statement is incorrect as the legal age requirement to become an organ donor varies by country or state, and it is not always 21 years of age.
D: "Your name cannot be removed once you are listed
Question 4 of 5
A parish nurse is leading a support group for clients whose family members have committed suicide. Which of the following strategies should the nurse plan to use during the group session?
Correct Answer: B
Rationale: The correct answer is B: Initiate a discussion with clients about ways to cope with changes in family dynamics. This is the most appropriate strategy as it addresses the immediate impact of the suicide on family dynamics and helps clients develop coping mechanisms. Discussing coping strategies can empower clients to navigate the difficult changes they are facing.
A: Encouraging clients to establish a timeline for their own grieving process may not be helpful as each individual grieves differently and timelines can vary significantly.
C: Assisting clients in identifying ways suicide could have been prevented may lead to feelings of guilt and self-blame, which can be harmful to the healing process.
D: Discouraging clients from sharing negative aspects of their relationship with the deceased person can hinder the expression of emotions and the processing of complex feelings related to the loss.
Question 5 of 5
A nurse is developing a care plan for a client who is in Buck's traction and is scheduled for surgery for a fractured femur of the right leg. Which of the following interventions should the nurse delegate to assistive personnel?
Correct Answer: D
Rationale:
Correct
Answer: D. Remind the client to use the incentive spirometer.
Rationale:
1. Incentive spirometer use is a task that can be safely delegated to assistive personnel.
2. It is a non-invasive procedure and does not require advanced nursing skills.
3. Using the incentive spirometer helps prevent respiratory complications post-surgery.
4. Assistive personnel can remind the client to use it regularly, promoting lung expansion and preventing atelectasis.
Summary of other choices:
A: Asking the client to describe pain requires nursing assessment skills.
B: Checking the client's pedal pulse requires nursing assessment skills.
C: Observing the position of the suspended weight requires nursing judgment to adjust if needed.