ATI Exit Exam 2024

Correct Answer: A

Rationale: The correct action the nurse should take is to administer the medication over 60 minutes. This is important because administering vancomycin over 60 minutes helps prevent red man syndrome, a reaction that can occur with rapid infusion. Monitoring the client's blood glucose level (Choice B) is unrelated to vancomycin administration. Infusing the medication rapidly (Choice C) is incorrect and can lead to adverse reactions. Administering the medication using a filter needle (Choice D) is unnecessary for vancomycin administration.

Correct Answer: C

Rationale: During the Passover holiday, individuals practicing Orthodox Judaism follow dietary restrictions that include avoiding leavened bread. Providing unleavened bread aligns with these restrictions and ensures the client's observance of the holiday. Choices A, B, and D are incorrect because serving chicken with cream sauce, avoiding fish with fins and scales, and avoiding foods containing lamb are not specific dietary requirements related to observing Passover in Orthodox Judaism.

Correct Answer: B

Rationale: The correct answer is B. Food exchange lists from the American Diabetes Association are a reliable resource for meal planning in diabetes. They provide structured guidance on appropriate food choices and portion sizes. Choice A, personal blogs, may not always offer accurate and evidence-based information. Choice C, diabetes medication information from the Physicians' Desk Reference, is not directly related to meal planning. Choice D, food label recommendations from the Institute of Medicine, while important for understanding nutritional content, may not provide the structured meal planning guidance needed for a client with type 2 diabetes mellitus.

Correct Answer: C

Rationale: Setting the IV pump to 125 mL/hr ensures the correct infusion rate for delivering 500 mL over 4 hours. To calculate the mL/hr rate, divide the total volume to be infused (500 mL) by the total time for infusion (4 hours): 500 mL / 4 hours = 125 mL/hr. Choice A (75 mL/hr) is too low and would result in an insufficient infusion rate, potentially delaying fluid resuscitation. Choice B (100 mL/hr) would also be too low and not deliver the fluid within the specified time frame. Choice D (150 mL/hr) is too high and would infuse the fluid too quickly, potentially causing fluid overload and complications.

Correct Answer: B

Rationale: The correct action for the nurse to take when caring for a client with alcohol use disorder experiencing withdrawal is to administer diazepam. Diazepam is a benzodiazepine commonly used to manage withdrawal symptoms in these clients by reducing anxiety, tremors, and the risk of seizures. Administering naloxone (Choice A) is used for opioid overdose, not alcohol withdrawal. Encouraging oral fluid intake (Choice C) is generally beneficial but not a specific intervention for alcohol withdrawal. Administering magnesium sulfate (Choice D) is not indicated for alcohol withdrawal but may be used for other conditions like preeclampsia or eclampsia.