ATI Exit Exam ( ATI Comprehensive Predictor)

Correct Answers B: Clings to others and C. Behaves submissively

Detailed Explanation:

Dependent personality disorder (DPD) is characterized by an excessive psychological dependence on other people. Clients with DPD often have a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation or abandonment. These clients tend to rely heavily on others to make decisions for them and may have difficulty expressing disagreement or initiating projects on their own due to a lack of self-confidence.

Manifestations you should expect include:

Clinging to others (B):

Clients with DPD tend to form relationships in which they rely heavily on others for emotional and physical support. They may be overly dependent on family members, friends, or partners and fear being alone.

Behaving submissively (C):

These clients often put others’ needs and desires ahead of their own. They might avoid conflict and submissively comply with others’ wishes to maintain support and approval.

Why the other options are incorrect:

Acts impulsively (A):

Impulsive behavior is typically seen in disorders such as borderline personality disorder, not in dependent personality disorder. Clients with DPD tend to avoid making decisions on their own rather than act impulsively.

Exhibits violent behavior (D):

Violence and aggression are not traits associated with dependent personality disorder. Instead, clients tend to be passive and avoid confrontation.

Lacks empathy (E):

A lack of empathy is more characteristic of antisocial personality disorder. Clients with dependent personality disorder usually are very sensitive to others’ feelings and strive to maintain harmonious relationships.

Summary:

The nurse should expect clients with dependent personality disorder to cling to others and behave submissively as they seek to maintain support and avoid abandonment. These behaviors reflect their deep fear of being alone and their need for care and guidance from others. They generally do not act impulsively, exhibit violence, or lack empathy.

Correct Answer:

C. Remove the restraints from the client.

Explanation:

Restraints should be discontinued as soon as the client no longer presents a threat to themselves or others. If the client is calm and cooperative, maintaining restraints is no longer justified and could be considered a violation of the client’s rights. The nurse should assess readiness for restraint removal and proceed with discontinuation following facility protocols, ensuring safety while promoting dignity.

Why Other Options Are Incorrect:

A. Encourage the client to attend a group therapy session.

While group therapy can be helpful in long-term treatment, it is not the immediate priority in this situation. The first action should be removing unnecessary restraints before transitioning the client to other therapeutic interventions. Encouragement to attend therapy can follow once the client is safely out of restraints.

B. Continue to monitor the client every 15 min.

Monitoring is essential while the client is in restraints. However, if the client is no longer aggressive, restraints should be discontinued. Continuing restraint without clinical justification can be considered unethical and potentially illegal, even if monitoring continues.

D. Offer the client PRN pain medication.

There is no indication in the scenario that the client is in pain. Offering PRN pain medication without assessing a need could be inappropriate and may distract from the actual priority — removing the restraints once they are no longer necessary.

Correct Answer C: I am starting to accept my new appearance.

Detailed Explanation:

Coping with body image changes after a mastectomy involves moving through stages of grief, loss, and eventual acceptance. Statements that reflect acceptance and acknowledgment of change indicate the client is beginning to adapt psychologically to the altered body image.

Why C is Correct:

The statement “I am starting to accept my new appearance” reflects the client’s progression toward psychological adjustment and coping. Acceptance is a positive step in regaining self-esteem and adapting to the physical changes caused by the surgery.

Why the other options are incorrect:

A. I hate my new body

This expresses anger and rejection, indicating the client is struggling with body image changes.

B. I feel so ugly

This reveals low self-esteem and negative feelings toward the new body image, showing the client has not yet begun coping effectively.

D. I can't stand to look at myself

This reflects distress and avoidance, signs that the client is still experiencing difficulty with body image changes.

Summary:

The client’s statement about beginning to accept her new appearance signals early coping with body image changes after mastectomy. This is a positive indicator of psychological adjustment, while negative or avoidant statements suggest ongoing distress and need for support.

Correct Answer:

B. Client statement

Explanation:

B. Client statement – The client states, "I want to stop and get better." This reflects insight, readiness for change, and engagement in the recovery process, which are essential for progress in the treatment of bulimia nervosa. Motivation to recover is a key psychological indicator that therapeutic interventions can begin to take effect.

Why Other Options Are Incorrect:

A. Vital signs – The client continues to have orthostatic hypotension (drop in BP when standing) and tachycardia, both of which indicate worsening or unresolved volume depletion, not improvement.

C. ECG – The Day 2 ECG findings are not provided here, but based on ongoing electrolyte abnormalities (notably low potassium), it's likely cardiac irritability (e.g., PVCs) may persist. No improvement can be confirmed in this area.

D. Electrolytes – Electrolyte levels have worsened since Day 1:

Potassium dropped from 3.0 to 2.9 mEq/L

Sodium dropped from 134 to 130 mEq/L

Albumin remains low

These changes suggest continued purging behavior and inadequate nutritional/fluid intake, not improvement.

Thus, the only indication of progress is the client’s verbal expression of wanting to recover, which reflects psychological readiness to engage in treatment.

Correct Answer: Apply anti-embolism stockings

Detailed Explanation of the Correct Answer:

Apply anti-embolism stockings

This is the correct answer. Anti-embolism stockings (also called TED hose) help promote venous return by applying graduated compression to the lower extremities. This improves blood flow, reduces venous stasis, and helps prevent deep vein thrombosis (DVT), especially in postoperative clients who are not yet ambulating.

Explanation of Incorrect Options:

 Administer a stool softener

 While stool softeners help prevent straining during bowel movements and reduce the risk of constipation, they do not directly promote venous return. However, they may be used to reduce Valsalva maneuver, which could indirectly benefit cardiovascular status, but it’s not the most relevant action for promoting venous return.

 Elevate the head of the bed

Elevating the head of the bed can help with respiratory function, but it does not assist with venous return from the lower extremities. In fact, for promoting venous return, elevating the legs is more beneficial.

 Encourage the client to cough and deep breathe

Coughing and deep breathing are important postoperative respiratory interventions to prevent atelectasis and pneumonia, but they do not directly promote venous return. Their primary focus is on lung expansion and airway clearance.

Summary:

To promote venous return in a postoperative client who is unable to ambulate, the nurse should apply anti-embolism stockings. These provide graduated compression to help blood flow back to the heart, reducing the risk of DVT. Other interventions listed are important but not directly related to enhancing venous return

Correct Answer:

A. "You can obtain a personal response system that will be activated if you fall."

Explanation:

A. "You can obtain a personal response system that will be activated if you fall."

A personal emergency response system (PERS) is an effective, immediate solution for clients who live alone and fear falling. These devices allow the user to call for help quickly, providing a sense of security and allowing them to maintain independence while ensuring rapid assistance if needed.

Why Other Options Are Incorrect:

B. "You need to move to a skilled nursing facility where they can prevent falls."

This is an extreme and unnecessary suggestion for someone who is expressing concern, not demonstrating current unsafe living conditions. It may also increase the client’s anxiety or resistance to asking for help.

C. "You can have an unlicensed assistive personnel (UAP) come to your house daily to stay with you."

While some clients may benefit from home care, a daily UAP presence is not always practical or necessary. It may not be covered by insurance and isn't the first-line recommendation for someone who is independent.

D. "You should contact a family member once a week to keep in touch."

Weekly contact is beneficial for emotional support but does not directly address the client’s concern about falling and being alone when it happens.

Correct Answer:

D. 1 cup cantaloupe

Explanation:

D. 1 cup cantaloupe

Cantaloupe provides over 400 mg of potassium per cup, making it an excellent food choice for clients with hypokalemia. Potassium helps maintain fluid balance, nerve signals, and muscle contractions, and cantaloupe offers a high concentration in a small serving size.

Why Other Options Are Wrong:

A. 1/2 cup apple juice

Apple juice contains about 120 mg of potassium per half cup, which is a low amount and not sufficient for correcting hypokalemia through diet.

B. 1/2 cup steamed cauliflower

Steamed cauliflower provides approximately 150 mg of potassium per half cup, which is inadequate for clients needing to increase potassium intake.

C. 1 cup boiled white rice

Boiled white rice contains less than 60 mg of potassium per cup, making it one of the least effective options for potassium replenishment.

Correct Answer:

C. "Older adults report pain less frequently than younger clients."

Explanation:

C. "Older adults report pain less frequently than younger clients."

Older adults may underreport pain due to beliefs that it is a normal part of aging or fear of addiction, side effects, or being a burden. This can lead to undertreatment. Nurses should assess for nonverbal cues and ensure regular pain assessments.

Why Other Options Are Incorrect:

A. "Opioids should not be given to older adults."

Opioids can be given to older adults when appropriate. However, they should be used cautiously, often starting at lower doses due to increased sensitivity and risk of side effects such as sedation or respiratory depression.

B. "Pain perception is decreased in older adult clients."

Pain perception does not necessarily decrease with age. While certain changes in the nervous system occur with aging, older adults still experience pain and should not be assumed to feel it less.

D. "Older adults require higher doses of pain medication."

Older adults usually require lower doses due to changes in drug metabolism and increased sensitivity. Starting low and titrating carefully is the recommended approach.

Correct Answer B: I will warm the crib sheets before putting my baby to bed.

Detailed Explanation:

Warming crib sheets before placing a newborn to sleep can help keep the baby comfortable, especially in colder environments. It is a safety-conscious behavior as long as safe sleep guidelines are followed, such as placing the baby on a firm mattress without loose bedding.

Why B is Correct:

Warming the sheets helps maintain the newborn’s body temperature without adding extra blankets or loose bedding, which reduces the risk of overheating or suffocation.

Why the Other Options Are Incorrect:

A. I will place my baby on his stomach when he is sleeping.

This is incorrect because placing a newborn on the stomach increases the risk of sudden infant death syndrome (SIDS). The recommended sleep position is on the back.

C. I should place the crib near a window to provide adequate sunlight and fresh air.

This is unsafe as windows can pose risks such as drafts, overheating, and potential injury if blinds or cords are accessible. The crib should be placed away from windows.

D. I should place my baby's stuffed animals between the mattress and side of the crib.

Stuffed animals and other soft objects should be kept out of the crib to prevent suffocation and reduce SIDS risk.

Summary:

The parent demonstrates understanding of safe crib practices by warming the crib sheets. The nurse should reinforce placing the baby on the back to sleep, keeping the crib away from windows, and removing soft items from the crib to ensure a safe sleep environment.