ATI RN
ATI RN Adult Medical Surgical 2023 Questions Correct Answers Questions
Extract:
Question 1 of 5
A nurse is admitting a client who reports tightness in their chest that radiates to left arm. Which of the following findings require immediate follow-up?
Correct Answer: B
Rationale: The correct answer is B: Heart rate 110/min and irregular. This finding suggests cardiac distress or arrhythmia, which could indicate a heart attack. Immediate follow-up is necessary to assess the client's cardiac status and intervene promptly.
Incorrect choices:
A: Temperature within normal range.
C: Respiratory rate within normal range.
D: Blood pressure slightly elevated but not an immediate concern.
E: Oxygen saturation slightly low but not critically low.
Question 2 of 5
A nurse is caring for a client who has COPD. Which of the following findings require immediate follow-up?
Correct Answer: D
Rationale: The correct answer is D. Tachypnea, productive cough with yellow mucus in a client with COPD indicate a potential exacerbation requiring immediate follow-up. Tachypnea suggests respiratory distress, while yellow mucus may indicate infection. Prompt intervention can prevent worsening respiratory status.
Choices A, B, and C do not indicate acute respiratory distress. Option E may be concerning but doesn't necessitate immediate intervention like option D does.
Question 3 of 5
A nurse is caring for a client who is experiencing an exacerbation of heart failure. Thenurse is assessing the client 24 hr later. How should the nurse interpret the findings related to the diagnosis of heart failure? For each finding, click to specify whe ther the finding is unrelated to the diagnosis, a sign of potential improvement, or a sign of potential worsening condition. Diagnostic Results Hgb 8.4 g/dL (12 to 18 g/dL) Hct 42% (37% to 47%) WBC count 9,800/mm3 (5,000 to 10,000/ mm3) Potassium 432 mEq/L (3.5 to 5 mEq/L)
| Findings 24 hr later | unrelated to the diagnosis | Potential improvement | Worsening condition |
|---|---|---|---|
| Lung sounds clean | |||
| Creatinine 1.8 mm/dl | |||
| Weight 113kg(249 lb) | |||
| WBC Count 11,800mm3 | |||
| Temperature: 38.5°C (101.3°F) | |||
| Shortness of breath with exertion |
Correct Answer: A, B,C,D,E
Rationale:
The correct answer is A, B, C, D, E. In heart failure exacerbation, key indicators are related to fluid overload and organ perfusion.
A) Lung sounds clean indicate potential improvement in pulmonary congestion.
B) Creatinine 1.8 mm/dl is important for kidney function monitoring, as worsening kidney function can occur in heart failure.
C) Weight 113kg reflects fluid retention, relevant for heart failure management.
D) WBC count (11,800mm3) can indicate infection, which can worsen heart failure. E) Temperature 38.5°C can suggest infection or systemic inflammatory response, which worsens heart failure.
Question 4 of 5
A nurse is caring for a client who has heart failure. Drag words from the choices below to fill in each blank in the following sentence. The client is at risk for developing _________ and_________ Word choices: dysrhythmias, respiratory alkalosis, acute kidney injury, fluid volume
Correct Answer: A
Rationale: The correct answer is A: Dysrhythmias. In heart failure, the reduced cardiac output can lead to inadequate perfusion, causing the heart to work harder, increasing the risk of dysrhythmias. Dysrhythmias are common in heart failure due to changes in the heart's structure and function. Respiratory alkalosis is less likely in heart failure as it is more commonly associated with conditions like hyperventilation. Acute kidney injury can occur in heart failure due to poor perfusion, but it is not directly related to the risk stated. Fluid volume deficit is not the typical risk in heart failure as patients usually have fluid retention.
Question 5 of 5
A nurse is providing teaching for a client who has diabetes mellitus about the self-administration of insulin.The client has prescriptions for regular and NPH insulins. Which of the following statements by the client indicates an understanding of the teaching?
Correct Answer: A
Rationale:
Correct
Answer: A: I will draw up the regular insulin into the syringe first.
Rationale: Drawing up regular insulin first is crucial for preventing contamination between the two insulins. Regular insulin is a clear solution and should be drawn up first to prevent any cloudiness or contamination from the NPH insulin, which is a cloudy suspension. Drawing up regular insulin first ensures accuracy in dosing and prevents mixing of the two insulins.
Incorrect
Choices:
B: Shaking the NPH vial vigorously before drawing up the insulin is incorrect as it can cause bubbles and affect the accuracy of the dose.
C: Storing prefilled syringes in the refrigerator with the needle pointed downward is incorrect as it can lead to leakage or contamination.
D: Inserting the needle at a 15-degree angle is incorrect as insulin injections should be administered at a 90-degree angle for proper absorption.