ATI RN COMPREHENSIVE EXIT EXAM 2020
(Detail Solutions)
1.A nurse is implementing interventions for a group of
patients. Which actions are nursing interventions?
(Select all that apply.)
a. Order chest x-ray for suspected arm fracture.
b. Prescribe antibiotics for a wound infection.
c. Reposition a patient who is on bed rest.
d. Teach a patient preoperative exercises.
e. Transfer a patient to another hospital unit.
ANS: C, D, E
A nursing intervention is any treatment based on clinical judgment and
knowledge that a nurse performs to enhance patient outcomes. Repositioning,
teaching, and transferring a patient are examples of nursing interventions.
Ordering a chest x-ray and prescribing antibiotics are examples of medical
interventions performed by a health care provider.
2. A nurse is providing nursing care to a group of patients. Which
actions are direct care interventions? (Select all that apply.)
a. Ambulating a patient
b. Inserting a feeding tube
c. Performing resuscitation
d. Documenting wound care
e. Teaching about medications
ANS: A, B, C, E
All of the interventions listed (ambulating, inserting a feeding tube,
performing resuscitation, and teaching) are direct care interventions involving
patient and nurse interaction, except documenting wound care. 1
Documenting wound care is an example of an indirect intervention.
, 3. A nurse is preparing to carry out interventions. Which
resources will the nurse make sure are available? (Select all that
apply.)
a. Equipment
b. Safe environment
c. Confidence
d. Assistive personnel
e. Creativity
ANS: A, B, D
A nurse will organize time and resources in preparation for implementing
nursing care. Most nursing procedures require some equipment or supplies.
Before performing an intervention, decide which supplies you need and
determine their availability. Patient care staff (assistive personnel) work
together as patients’ needs demand it. A patient’s care environment needs to be
safe and conducive to implementing therapies. Confidence and creativity are
needed to provide safe and effective patient care; however, these are critical
thinking attitudes, not resources.
4. Which interventions are appropriate for a patient with diabetes
and poor wound healing? (Select all that apply.)
a. Perform dressing changes twice a day as ordered.
b. Teach the patient about signs and symptoms of infection.
c. Instruct the family about how to perform dressing changes.
d. Gently refocus patient from
discussing body image changes.
Administer medications to control
the patient’s blood sugar as
e. ordered.
ANS: A, B, C, E
Nursing priorities include interventions directed at enhancing wound healing.
Teaching the patient about signs and symptoms of infection will help the
patient identify signs of appropriate wound healing and know when the need
for calling the health care provider arises. Performing dressing changes, 2
controlling blood sugars through administration of medications, and
instructing the family in dressing changes all contribute to wound healing. As
, long as a patient is stable and alert, it is appropriate to allow family to assist
with care. The patient should be allowed to discuss body image changes.
1. A nurse determines that the patient’s condition has improved and has
met expected outcomes. Which step of the nursing process is the nurse
exhibiting?
a. Assessment
b. Planning
c. Implementation
d. Evaluation
ANS: D
Evaluation, the final step of the nursing process, is crucial to determine
whether, after application of the first four steps of the nursing process, a
patient’s condition or well-being improves and if goals have been met.
Assessment, the first step of the process, includes data collection. Planning,
the third step of the process, involves setting priorities, identifying patient
goals and outcomes, and selecting nursing interventions. During
implementation, nurses carry out nursing care, which is necessary to help
patients achieve their goals.
2. A nurse completes a thorough database and carries out nursing
interventions based on priority diagnoses. Which action will the nurse take
next?
a. Assessment
b. Planning
c. Implementation
d. Evaluation
ANS: D
Evaluation, the final step of the nursing process, is crucial to determine
whether, after application of the first four steps of the nursing process, a
patient’s condition or well-being improves. Assessment involves gathering
information about the patient. During the planning phase, patient outcomes
are determined. Implementation involves carrying out appropriate nursing
interventions. 3
3. A new nurse asks the preceptor to describe the primary purpose of
(Detail Solutions)
1.A nurse is implementing interventions for a group of
patients. Which actions are nursing interventions?
(Select all that apply.)
a. Order chest x-ray for suspected arm fracture.
b. Prescribe antibiotics for a wound infection.
c. Reposition a patient who is on bed rest.
d. Teach a patient preoperative exercises.
e. Transfer a patient to another hospital unit.
ANS: C, D, E
A nursing intervention is any treatment based on clinical judgment and
knowledge that a nurse performs to enhance patient outcomes. Repositioning,
teaching, and transferring a patient are examples of nursing interventions.
Ordering a chest x-ray and prescribing antibiotics are examples of medical
interventions performed by a health care provider.
2. A nurse is providing nursing care to a group of patients. Which
actions are direct care interventions? (Select all that apply.)
a. Ambulating a patient
b. Inserting a feeding tube
c. Performing resuscitation
d. Documenting wound care
e. Teaching about medications
ANS: A, B, C, E
All of the interventions listed (ambulating, inserting a feeding tube,
performing resuscitation, and teaching) are direct care interventions involving
patient and nurse interaction, except documenting wound care. 1
Documenting wound care is an example of an indirect intervention.
, 3. A nurse is preparing to carry out interventions. Which
resources will the nurse make sure are available? (Select all that
apply.)
a. Equipment
b. Safe environment
c. Confidence
d. Assistive personnel
e. Creativity
ANS: A, B, D
A nurse will organize time and resources in preparation for implementing
nursing care. Most nursing procedures require some equipment or supplies.
Before performing an intervention, decide which supplies you need and
determine their availability. Patient care staff (assistive personnel) work
together as patients’ needs demand it. A patient’s care environment needs to be
safe and conducive to implementing therapies. Confidence and creativity are
needed to provide safe and effective patient care; however, these are critical
thinking attitudes, not resources.
4. Which interventions are appropriate for a patient with diabetes
and poor wound healing? (Select all that apply.)
a. Perform dressing changes twice a day as ordered.
b. Teach the patient about signs and symptoms of infection.
c. Instruct the family about how to perform dressing changes.
d. Gently refocus patient from
discussing body image changes.
Administer medications to control
the patient’s blood sugar as
e. ordered.
ANS: A, B, C, E
Nursing priorities include interventions directed at enhancing wound healing.
Teaching the patient about signs and symptoms of infection will help the
patient identify signs of appropriate wound healing and know when the need
for calling the health care provider arises. Performing dressing changes, 2
controlling blood sugars through administration of medications, and
instructing the family in dressing changes all contribute to wound healing. As
, long as a patient is stable and alert, it is appropriate to allow family to assist
with care. The patient should be allowed to discuss body image changes.
1. A nurse determines that the patient’s condition has improved and has
met expected outcomes. Which step of the nursing process is the nurse
exhibiting?
a. Assessment
b. Planning
c. Implementation
d. Evaluation
ANS: D
Evaluation, the final step of the nursing process, is crucial to determine
whether, after application of the first four steps of the nursing process, a
patient’s condition or well-being improves and if goals have been met.
Assessment, the first step of the process, includes data collection. Planning,
the third step of the process, involves setting priorities, identifying patient
goals and outcomes, and selecting nursing interventions. During
implementation, nurses carry out nursing care, which is necessary to help
patients achieve their goals.
2. A nurse completes a thorough database and carries out nursing
interventions based on priority diagnoses. Which action will the nurse take
next?
a. Assessment
b. Planning
c. Implementation
d. Evaluation
ANS: D
Evaluation, the final step of the nursing process, is crucial to determine
whether, after application of the first four steps of the nursing process, a
patient’s condition or well-being improves. Assessment involves gathering
information about the patient. During the planning phase, patient outcomes
are determined. Implementation involves carrying out appropriate nursing
interventions. 3
3. A new nurse asks the preceptor to describe the primary purpose of
