ATI RN
ATI Comprehensive 2023 With NGN 180 Questions And Answers Questions
Extract:
A nurse is planning care for a client who was receiving continuous internal tube feeding through an open system.
Question 1 of 5
Which intervention should the nurse include in the plan of care?
Correct Answer: E
Rationale: The correct answer is E, replacing the feeding container and tubing every 24 hours. This intervention is crucial to prevent bacterial contamination and ensure the patient's safety. By replacing the container and tubing regularly, the nurse helps maintain a sterile environment for the enteral feeding, reducing the risk of infection.
Choice A is incorrect because leaving formula in the container for 18 hours can lead to bacterial growth and contamination.
Choice B, flushing the feeding tube with water every 4 to 6 hours, is important for tube patency but does not address the need for replacing the container and tubing.
Choice C, covering and labeling the formula container, is a good practice for storage but does not address the need for regular replacement.
Choice D, elevating the head of the bed during feeding, is important for preventing aspiration but is not directly related to the maintenance of feeding equipment.
Extract:
A nurse is caring for a client who asks for information regarding organ donation.
Question 2 of 5
Which statement should the nurse make?
Correct Answer: E
Rationale: The correct answer is E because it addresses a common misconception. Organ donor status does not affect medical care provided before death.
Choice A is incorrect as organ donor consent can also be verbal.
Choice B is incorrect because changing one's decision about organ donation may not always be feasible in emergency situations.
Choice C is incorrect as discussing wishes with family does not guarantee they will be honored legally.
Choice D is incorrect as organ donation may have some impact on funeral arrangements and body appearance.
Extract:
A nurse is caring for a client who has placenta previa.
Question 3 of 5
Which finding should the nurse expect?
Correct Answer: B
Rationale: The correct answer is B: Painless, bright red vaginal bleeding. This finding is indicative of placenta previa, a condition where the placenta partially or completely covers the cervix. The bright red color indicates fresh bleeding. Spotting (choice
A) is more commonly associated with implantation bleeding in early pregnancy. A soft, relaxed, and non-tender uterus (choice
C) is not specific to any particular condition. A fundal height greater than expected for gestational age (choice
D) could indicate fetal macrosomia or polyhydramnios, but it is not related to the scenario described. While fetal heart rate within normal limits (choice E) is important, it is not the most relevant finding in this case.
Extract:
A charge nurse is concerned about a recent increase in facility-acquired catheter infections.
Question 4 of 5
Which action should the nurse take?
Correct Answer: E
Rationale: The correct action for the nurse to take is E: Conduct regular audits on catheter care compliance. Audits help monitor adherence to catheter care protocols, identify areas needing improvement, and ensure staff follow best practices consistently. This action promotes quality care, reduces infection risks, and enhances patient safety.
Choices A, B, C, and D are important but do not directly address ongoing monitoring and assessment of compliance like regular audits do. Conducting audits is a proactive approach to continuously evaluate and improve catheter care practices, making it the most appropriate action in this scenario.
Extract:
A nurse is assessing the grief response of a client whose child died six months ago.
Question 5 of 5
Which client statement should the nurse report as an indication of major depressive disorder?
Correct Answer: E
Rationale: The correct answer is E because suicidal ideation is a significant red flag for major depressive disorder. This statement indicates severe emotional distress and potential risk for self-harm.
Choices A, B, C, and D are common symptoms of depression but do not necessarily point to the severity and immediate risk of suicide like choice E does. Reporting suicidal thoughts is crucial for timely intervention and ensuring the client's safety.