ATI RN
ATI Comprehensive 2023 With NGN 180 Questions And Answers Questions
Extract:
A nurse is planning care for a client who is to receive alteplase recombinant for a thrombus in the coronary artery.
Question 1 of 5
Which of the following actions should the nurse include in the plan of care?
Correct Answer: A
Rationale: The correct answer is A: Observe for bruising of the skin. This is important in assessing for signs of potential bleeding, which could indicate a complication. Monitoring for bruising can help detect early signs of internal bleeding, especially in patients at risk due to certain medical conditions or medication use. Providing a diet low in protein (
B) is not relevant to the question and could potentially harm the patient's nutritional status. Monitoring vital signs every hour for the first 4 hours (
C) may not be necessary unless there are specific indications for frequent monitoring. Administering medications intramuscularly (
D) is not directly related to observing for bruising and may not be the priority in this situation.
Extract:
A nurse is teaching a newly licensed nurse about caring for clients in the emergency department.
Question 2 of 5
Which of the following actions should the nurse include when teaching about interacting with a client who is aggravated, pacing, and speaking loudly?
Correct Answer: B
Rationale: The correct answer is B: Tell the client, 'You seem to be very upset.' This response shows empathy and validates the client's feelings, which can help de-escalate the situation. It acknowledges the client's emotions without escalating them further. Initiating seclusion protocol (
A) is inappropriate as it can escalate the situation and is a last resort for safety. Standing directly in front of the client and maintaining eye contact (
C) can be perceived as confrontational and may escalate the situation. Speaking in a firm and authoritative tone (
D) can further aggravate the client and escalate the situation.
Extract:
A nurse is caring for a client who is pregnant. Nurses'
Notes
Day 1, 0900:
Client is at 31 weeks of gestation and presents with a severe headache unrelieved by
acetaminophen. Client also reports urinary frequency and decreased fetal movement.
Client is a G3 P2 with one preterm birth.
Vital Signs Day
1, 0900:
Temperature (oral) 36.9°C (98,4° F) Heart
rate 72/min
Respiratory rate 16/min BP
162/112 mm Hg
Oxygen saturation 97% on room air
Diagnostic Results Day 1,
1000:
Appearance cloudy (clear) Color
yellow (yellow)
pH 5.9 (4.6 to 8)
Protein 3+ (negative)
Specific gravity 1.013 (1.005 to 1.03) Leukocyte esterase
negative (negative)
Nitrites negative (negative) Ketones
negative (negative) Crystals negative
(negative) Casts negative (negative)
Glucose trace (negative) WBC 5 (0
t0 4)
WBC casts none (none)
RBC 1 (less than or equal to 2) RBC
casts none (none)
Question 3 of 5
The nurse is reviewing the client's medical record. Select 4 findings that indicate a potential prenatal complication.
Correct Answer: A,C,F,G
Rationale: The correct answers are A, C, F, and G. A high urine protein level indicates possible preeclampsia, a serious prenatal complication. Elevated blood pressure is also a sign of preeclampsia. Headaches can be a symptom of hypertension or preeclampsia. Gravida/parity helps assess the client's obstetric history, which can indicate potential complications. Fetal activity, urine ketones, and respiratory rate are not direct indicators of prenatal complications.
Extract:
A charge nurse is teaching a new staff member about factors that increase a client's risk to become violent.
Question 4 of 5
Which risk factor should the nurse include as the best predictor of future violence?
Correct Answer: A
Rationale: The correct answer is A: Previous violent behavior. This is the best predictor of future violence because past behavior is a strong indicator of future actions. Research shows that individuals with a history of violence are more likely to engage in violent behavior again. This pattern of behavior is often consistent over time. Low self-esteem (
B), substance use disorder (
C), and a history of depression (
D) can contribute to violence but are not as reliable predictors as previous violent behavior. These factors may increase the risk of violence but do not have the same level of predictive value as an individual's history of violent behavior.
Extract:
A nurse is caring for a client who has a stool culture that is positive for Clostridium difficile.
Question 5 of 5
Which of the following infection control precautions should the nurse take?
Correct Answer: B
Rationale: The correct answer is B because placing the client in a private room with contact precautions helps prevent the spread of infection to others. This measure includes using personal protective equipment (PPE) and limiting contact with others to contain potential infectious agents. Removing the protective gown in the client's room (
A) is incorrect as it exposes the nurse to potential contamination. Performing hand hygiene with an alcohol-based sanitizer (
C) is important but does not address the isolation of the client. Wearing an N95 mask (
D) is specific to airborne precautions, not contact precautions.