ATI RN
RN ATI FUNDAMENTALS 2024 EXAM Questions
Extract:
Question 1 of 5
A nurse is evaluating a client's use of a cane. Which of the following actions should the nurse identify as an indication of correct use?
Correct Answer: D
Rationale:
Correct
Answer: D: The client holds the cane on the stronger side of her body.
Rationale:
1. Holding the cane on the stronger side provides better stability and support.
2. This position allows the client to shift weight onto the cane during walking.
3. It helps to reduce pressure on the weaker side, promoting balance and preventing falls.
Incorrect
Choices:
A: The top of the cane parallel to the client's wrist is not directly related to correct use.
B: Walking is a general action, not specific to correct cane use.
C: Specific measurements of cane movement are not essential for correct use.
E: Moving the stronger limb forward with the cane does not ensure proper use.
Question 2 of 5
A nurse is caring for a client who has a terminal illness, and the client's partner indicates effective coping. The nurse should recognize that which of the following statements is an indication of effective coping?
Correct Answer: B
Rationale: The correct answer is B: "I am relying on support from our family during this time." This statement indicates effective coping because it acknowledges the importance of seeking and utilizing support from family members, which can help reduce feelings of isolation and provide emotional strength. By relying on family support, the client's partner is demonstrating a healthy coping mechanism that promotes resilience and emotional well-being during a challenging situation.
Choice A is incorrect because relying solely on hope without acknowledging the need for support may not address the partner's emotional needs effectively.
Choice C is incorrect as it demonstrates denial of the terminal illness and avoidance of the current reality.
Choice D is incorrect as it suggests avoidance of discussing important end-of-life decisions, which can hinder effective coping and planning.
Question 3 of 5
A nurse is admitting a client who is having an exacerbation of heart failure. In planning this client's care, when should the nurse initiate discharge planning?
Correct Answer: A
Rationale:
Correct
Answer: A. During the admission process.
Rationale: Discharge planning should start early to ensure a smooth transition. During admission, the nurse can assess the client's needs, resources, and support system. This allows time to address any potential barriers to discharge and create a comprehensive plan. Starting discharge planning later may lead to delays and inadequate preparation for the client's transition. Initiating discharge planning during the admission process promotes continuity of care and helps prevent readmissions.
Summary of Other
Choices:
B: Waiting until the client's condition is stable may delay discharge planning and increase the risk of complications during the transition.
C: Waiting for the initial team conference may result in missed opportunities to address discharge needs promptly.
D: Involving the client's family is important, but discharge planning should start early to ensure all aspects of the plan are considered and implemented effectively.
Question 4 of 5
A nurse is assessing four adult clients. Which of the following physical assessment techniques should the nurse use?
Correct Answer: B
Rationale: The correct answer is B: Ensure the bladder or the blood pressure cuff surrounds 50% of the client's arm. This is the correct physical assessment technique because proper cuff placement is essential for accurate blood pressure measurement. Placing the cuff around 50% of the arm circumference ensures that the blood pressure reading is not falsely elevated or decreased. Incorrect choices: A: Using the FLACC pain rating scale is relevant for pain assessment, but not a physical assessment technique. C: Obtaining an apical heart rate by auscultating at the third intercostal space left of the sternum is incorrect as the fifth intercostal space at the midclavicular line is the correct location. D: Palpating the client's abdomen before auscultating bowel sounds is incorrect as bowel sounds should be auscultated first to prevent stimulating peristalsis.
Question 5 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 is because anti-cholinergic medications can help reduce secretions in the airway, thus improving the client's breathing and reducing the noisy respirations. Turning the client every 2 hours (choice
A) may provide comfort but does not address the immediate issue of airway secretions. Holding oral care (choice
C) is important for overall comfort but does not directly address the client's breathing difficulty. Increasing the room's temperature (choice
D) is unlikely to improve the client's respiratory distress and may even make it worse.