ATI RN
ATI Medical Surgical Proctored Exam 2023 With NGN Questions and Correct Answers Questions
Extract:
Question 1 of 4
A nurse is planning care for a client who has dementia and a history of wandering. Which of the following actions should the nurse plan to implement?
Correct Answer: C
Rationale: The correct answer is C: Use a bed alarm. This option promotes client safety by alerting the nurse when the client attempts to leave the bed, reducing the risk of wandering. Moving the client to a double room (
A) does not address the wandering behavior. Using chemical restraints (
B) is unethical and can lead to adverse effects. Encouraging excessive stimulation (
D) can escalate agitation and wandering behavior.
Question 2 of 4
A nurse is caring for a client receiving TPN. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Monitor serum blood glucose during infusion. This is crucial because TPN (total parenteral nutrition) is a high concentration of glucose and can lead to hyperglycemia. Regular monitoring helps in detecting and managing any glucose fluctuations promptly.
Choice B is incorrect as daily weight is essential but not the priority when compared to monitoring glucose.
Choice C is incorrect as infusing 0.9% sodium chloride as an alternative can lead to incompatible solutions and cause harm.
Choice D is incorrect because verifying the solution with another RN is important for safety but does not address the immediate need for glucose monitoring.
Question 3 of 4
A nurse is caring for a client who has acute angina. Which of the following actions should the nurse take first?
Correct Answer: B
Rationale: The correct answer is B: Administer aspirin. Aspirin helps to reduce platelet aggregation and prevent further clot formation in clients with acute angina, thus reducing the risk of myocardial infarction. Administering aspirin should be the first action as it addresses the immediate risk of clot formation and helps improve blood flow to the heart muscle.
Measuring blood pressure (
A) can be important but is not the priority in this situation. Administering nitroglycerin (
C) is important for symptom relief but does not address the underlying cause. Initiating IV access (
D) may be necessary later for further interventions, but it is not the first priority.
Question 4 of 4
A nurse is assessing a client who has skeletal traction for a femoral fracture. The nurse notes that the weights are resting on the floor. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct action for the nurse to take is to reapply the weights to ensure proper traction. This is crucial to maintain the intended pulling force required for the skeletal traction to be effective in realigning the fractured bone. If the weights are resting on the floor, it means that the traction is not being applied as intended, which can lead to ineffective treatment and potential complications. Removing a weight (choice
A) would decrease the traction force, tying knots in the ropes (choice
B) would alter the mechanics of the system, and increasing the elevation of the extremity (choice
C) would not address the issue of weights resting on the floor.
Therefore, the best course of action is to reapply the weights to ensure proper traction and alignment of the fractured bone.
Question 5 of 4
A nurse is caring for a client who is receiving morphine through a PCA device. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Teach the client how to self-medicate using the PCA device. This is important because it empowers the client to control their pain management while ensuring safety. Teaching the client how to use the PCA device helps promote autonomy and ensures that the client is receiving the appropriate dose of medication as prescribed. Encouraging family members to press the button (
B) may lead to inappropriate dosing and compromise the client's safety. Monitoring respiratory status (
C) is important but should be done more frequently, such as every hour, as respiratory depression can occur with morphine use. Administering an oral opioid for breakthrough pain (
D) may not be necessary if the client is able to self-medicate effectively with the PCA device.