ATI RN
RN Comprehensive Predictor Questions
Extract:
Question 1 of 5
A nurse is planning care for a client who has a history of urinary tract infections (UTIs) and requires placement of an indwelling urinary catheter. Which of the following actions should the nurse take to help minimize the client's risk for acquiring a UTI?
Correct Answer: B
Rationale: The correct answer is B: Keep the urinary bag at bladder level when ambulating. This helps prevent reflux of bacteria into the bladder, reducing the risk of UTI. When the bag is below bladder level, gravity assists in drainage, minimizing the chance of urine backflow.
A: Looping the tubing below the collection bag can lead to urine reflux and bacterial contamination.
C: Disconnecting tubing connections increases the risk of introducing bacteria into the system.
D: Securing the catheter to the thigh does not directly impact UTI risk; it is for stability and comfort.
Question 2 of 5
A nurse is caring for a client who is taking antihypertensive medication and is moving from a supine to a sitting position. Which of the following findings should indicate to the nurse that the client is experiencing orthostatic hypotension?
Correct Answer: D
Rationale:
Correct
Answer: D - The client's systolic blood pressure decreases by 25 mm Hg.
Rationale: Orthostatic hypotension occurs when there is a significant drop in blood pressure upon changing positions. A decrease in systolic blood pressure by 20-30 mm Hg or more is a classic sign of orthostatic hypotension. This drop in blood pressure can lead to dizziness, lightheadedness, or fainting when moving from lying to sitting or standing.
Summary:
A - An increase in heart rate by 10/min is not a specific indicator of orthostatic hypotension.
B - An increase in diastolic blood pressure by 10 mm Hg is not a typical finding in orthostatic hypotension.
C - Heart palpitations may indicate other cardiac issues but are not specific to orthostatic hypotension.
D - Correct: A significant drop in systolic blood pressure is a hallmark sign of orthostatic hypot
Question 3 of 5
A nurse is assessing a child who is postoperative following a tonsillectomy. Which of the following findings should the nurse identify as the priority?
Correct Answer: B
Rationale: The correct answer is B: Frequent swallowing. This is the priority finding because it could indicate bleeding post-tonsillectomy, which is a medical emergency. The nurse should assess for other signs of hemorrhage such as tachycardia, pallor, and hypotension. Sore throat (
A) and blood-tinged mucus (
C) are common after tonsillectomy. Dark brown emesis (
D) could indicate old blood but is not as concerning as frequent swallowing.
Question 4 of 5
A nurse is teaching a client who is pregnant about nonstress testing. Which of the following statements by the client indicates an understanding of the teaching?
Correct Answer: D
Rationale: The correct answer is D: During this test, I will push a button if my baby moves. This statement indicates an understanding of the nonstress test (NST) procedure, where the client pushes a button each time they feel the baby move, allowing monitoring of fetal heart rate acceleration in response to fetal movement. This is crucial for assessing fetal well-being.
A: Incorrect. Oxytocin is not typically used in NST; it is used to induce or augment labor.
B: Incorrect. Fasting is not required for an NST.
C: Incorrect. NST does not detect genetic problems; it assesses fetal well-being based on heart rate patterns.
E, F, G: These options are not relevant to the NST procedure.
In summary, option D correctly describes the client's role in the NST, while the other options are not relevant to the test or suggest misunderstandings.
Question 5 of 5
A nurse is teaching a class about providing care within the legal scope of practice to a group of nurses. The nurse should include that which of the following procedures is outside the legal scope of practice for an RN?
Correct Answer: B
Rationale:
Correct
Answer: B - Inserting a tunneled central venous catheter is outside the legal scope of practice for an RN.
Rationale:
1. Scope of Practice: Inserting tunneled central venous catheters is a specialized procedure typically performed by healthcare providers with advanced training, such as physicians or specially trained nurses.
2. Risk of Complications: The insertion of central venous catheters carries a higher risk of complications, including infection, pneumothorax, and vascular injury, which require specialized skills to manage effectively.
3. Legal Regulations: State laws and regulations govern the scope of practice for healthcare professionals, and performing procedures outside of one's legal scope can result in legal consequences, such as loss of licensure or malpractice claims.
Summary:
A - Changing the inner cannula on a tracheostomy: Within the RN's legal scope of practice.
C - Irrigation of an external ear canal: Within the RN's legal scope of practice.
D -