ATI RN
clinical skills questions Questions
Question 1 of 5
Which of the following patients is at the highest risk for hyperosmolar hyperglycemic syndrome?
Correct Answer: D
Rationale: The correct answer is D because the 83-year-old long-term care resident with type 2 diabetes and advanced Alzheimer's disease who recently developed influenza is at the highest risk for hyperosmolar hyperglycemic syndrome (HHS). This patient has multiple risk factors for HHS, including age, type 2 diabetes, advanced Alzheimer's disease, and the added stress of influenza, which can exacerbate hyperglycemia. The combination of these factors can lead to severe hyperglycemia, dehydration, and electrolyte imbalances characteristic of HHS.
Choice A is incorrect because although excessive exercise can lead to hypoglycemia in individuals with type 1 diabetes, it is not a risk factor for HHS.
Choice B is incorrect as forgetting to take insulin can lead to diabetic ketoacidosis in type 1 diabetes, not HHS.
Choice C is incorrect as starting insulin injections in a patient with type 2 diabetes and coronary artery disease does not automatically increase the risk
Question 2 of 5
The nurse is assigned to care for a patient who presented to the emergency department with diabetic ketoacidosis. A continuous insulin intravenous infusion is started, and hourly bedside glucose monitoring is ordered. The targeted blood glucose value after the first hour of therapy is
Correct Answer: C
Rationale: The correct answer is C: a decrease of 35 to 90 mg/dL compared with admitting values. In diabetic ketoacidosis, there is severe hyperglycemia which needs to be corrected gradually to prevent complications like cerebral edema. A rapid decrease in glucose levels can lead to osmotic shifts and neurological issues. The targeted decrease of 35 to 90 mg/dL is considered safe and effective in managing hyperglycemia in these patients. This range ensures a controlled reduction in blood glucose levels without causing harm.
Choice A (70 to 120 mg/dL) is too broad and may lead to overly aggressive treatment.
Choice B (a decrease of 25 to 50 mg/dL) is too conservative and may not adequately address the high glucose levels seen in diabetic ketoacidosis.
Choice D (less than 200 mg/dL) does not provide a specific target range for glucose reduction, which is essential in managing diabetic ketoacidosis effectively.
Question 3 of 5
A patient is receiving hydrocortisone sodium succinate for adrenal crisis. What other medication does the nurse prepare to administer?
Correct Answer: B
Rationale: The correct answer is B: A proton pump inhibitor. When a patient is receiving hydrocortisone for adrenal crisis, it can lead to increased gastric acid secretion. A proton pump inhibitor helps reduce acid production and prevents gastric ulcers. Regular insulin (
A) is not typically indicated in this scenario. Canagliflozin (
C) is a medication used for diabetes management and is not relevant here. Propranolol (
D) is a beta-blocker and may mask signs of hypoglycemia when used with insulin, which is not suitable in this case.
Question 4 of 5
A patient is admitted to the oncology unit with a small-cell lung carcinoma. During the admission, the patient is noted to have a significant decrease in urine output accompanied by shortness of breath, edema, and mental status changes. The nurse is aware that this clinical presentation is consistent with
Correct Answer: D
Rationale: The correct answer is D: syndrome of inappropriate secretion of antidiuretic hormone (SIADH). In this scenario, the patient's symptoms of decreased urine output, shortness of breath, edema, and mental status changes are indicative of fluid overload due to SIADH. SIADH causes excessive release of antidiuretic hormone (ADH), leading to water retention and dilutional hyponatremia. This results in edema, decreased urine output, and neurological symptoms.
A: Adrenal crisis presents with hypotension, shock, and electrolyte abnormalities, not consistent with the patient's symptoms.
B: Diabetes insipidus would present with excessive urine output and thirst, opposite of the patient's symptoms.
C: Myxedema coma results from severe hypothyroidism and presents with hypothermia, bradycardia, and altered mental status, not consistent with the patient's symptoms.
In summary, the patient's clinical presentation aligns
Question 5 of 5
An individual with type 2 diabetes who takes glipizide has begun a formal exercise program at a local gym. While exercising on the treadmill, the individual becomes pale, diaphoretic, shaky, and has a headache. The individual feels as though she is going to pass out. What is the individual’s priority action?
Correct Answer: B
Rationale: The correct answer is B: Eat something with 15 g of simple carbohydrates. In this scenario, the individual is exhibiting signs of hypoglycemia due to the combination of glipizide (which can lower blood sugar) and exercise. The priority action is to raise blood sugar levels quickly to prevent further complications. Consuming simple carbohydrates, like glucose tablets or juice, will rapidly increase blood sugar levels. This is crucial to prevent the individual from passing out or experiencing more serious consequences.
Choice A is incorrect because while hydration is important, it is not the immediate priority in this situation.
Choice C is incorrect as going to the first-aid station may waste valuable time when immediate action is needed.
Choice D is incorrect as taking another dose of the oral agent can further lower blood sugar levels and worsen the hypoglycemia.