ATI RN
ATI RN Fundamentals 2023 Exam 5 Questions
Extract:
Question 1 of 5
A nurse says to their nurse manager, 'I'm the only one on my team who is working hard.' Which of the following responses should the nurse manager make?
Correct Answer: A
Rationale: Why do you feel upset about this?' opens dialogue to explore the nurse’s concerns constructively. Other responses are dismissive, punitive, or assume feelings without fostering discussion.
Question 2 of 5
A nurse is caring for a client who is exhibiting violent behavior and requires the application of wrist restraints. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: Quick-release ties ensure safety by allowing rapid removal in emergencies. A prescription is needed but not the first action. Securing to side rails risks injury, and two fingers (not three) is the correct spacing.
Question 3 of 5
A nurse on a surgical unit is caring for a client who is scheduled for surgery. The client states, 'I cannot do this. I do not want this surgery.' Which of the following actions should the nurse take?
Correct Answer: B
Rationale: Telling the client about the benefits of the surgery might seem helpful, but it does not address the client's immediate concern. The client has expressed a clear decision to refuse the surgery, and the nurse must respect this decision by informing the surgeon. This approach aligns with the ethical principle of respecting patient autonomy. Letting the client know that their surgeon will be notified of their decision is the correct action. This respects the client's autonomy and ensures that the surgeon is aware of the client's wishes. It also allows for further discussion between the client and the surgeon, where the client can receive more detailed information and support. Reassuring the client that it is expected to be nervous before surgery is supportive but does not address the client's refusal. While it is important to acknowledge the client's feelings, the nurse must also take appropriate steps to respect the client's decision and inform the surgeon. Informing the client that it is too late to stop the surgery is incorrect and unethical. Patients have the right to refuse treatment at any time, and it is the nurse's duty to respect and facilitate this decision.
Question 4 of 5
A nurse is providing teaching to a client about colorectal cancer prevention guidelines. Which of the following recommendations should the nurse include?
Correct Answer: C
Rationale: The recommendation for fecal occult blood tests (FOBT) is typically to have them annually, not every 2 years. Regular screening is crucial for early detection of colorectal cancer. The American Cancer Society suggests that people aged 45 and older should have an FOBT every year. This test helps detect hidden blood in the stool, which can be an early sign of cancer. Dietary fiber is actually beneficial in reducing the risk of colorectal cancer. High-fiber diets, rich in fruits, vegetables, and whole grains, are associated with a lower risk of developing colorectal cancer. Fiber helps in maintaining a healthy digestive system and can aid in the prevention of cancer by promoting regular bowel movements and reducing the time that potential carcinogens stay in the colon. Reducing the intake of red meats is a well-supported recommendation for lowering the risk of colorectal cancer. Studies have shown that high consumption of red and processed meats is linked to an increased risk of colorectal cancer. Reducing the intake of these meats and opting for healthier protein sources like fish, poultry, and plant-based proteins can help lower this risk. The standard recommendation for colonoscopy screening is every 10 years for individuals at average risk, starting at age 45. More frequent colonoscopies, such as every 3 years, are generally reserved for those with higher risk factors, such as a family history of colorectal cancer or the presence of polyps. Regular colonoscopy screenings are vital for detecting and removing polyps before they can develop into cancer.
Question 5 of 5
A nurse is planning care for a client who has a seizure disorder. Which of the following actions should the nurse include in the client's plan of care?
Correct Answer: C
Rationale: Having a padded tongue blade available at the client's bedside is not recommended for seizure management. Inserting any object into a patient's mouth during a seizure can cause injury to the teeth, gums, or jaw. Current guidelines advise against placing anything in the mouth of a person having a seizure. Instead, focus should be on ensuring the patient's safety by turning them on their side to maintain an open airway and prevent aspiration. Keeping the four side rails down when the client is in bed is not advisable for a client with a seizure disorder.
To prevent injury during a seizure, it is important to keep the side rails up and padded. This helps prevent the client from falling out of bed and sustaining injuries. Additionally, the bed should be kept in its lowest position to minimize the risk of injury from falls. Keeping suction equipment available in the client's room is crucial for managing a client with a seizure disorder. During a seizure, there is a risk of aspiration due to excessive salivation or vomiting. Having suction equipment readily available allows the nurse to quickly clear the client's airway, reducing the risk of aspiration and ensuring the client can breathe properly. Having wire cutters available at the client's bedside is not typically necessary for managing a seizure disorder. They are sometimes mentioned in the context of clients with Vagus Nerve Stimulators (VNS), where wire cutters might be used in an emergency to cut the VNS wire. However, this is a rare situation and not a standard precaution for all clients with seizure disorders.