ATI RN
ATI RN Fundamentals 2023 Exam 3 Questions
Question 1 of 5
A nurse is assessing a client who has hypocalcemia. Which of the following findings should the nurse expect? (Select all that apply.)
Correct Answer: A,C,E
Rationale: The correct answers are A, C, and E. Hypocalcemia causes neuromuscular irritability.
A) Tingling sensation around the lips is due to hypocalcemia affecting the peripheral nerves.
C) Positive Trousseau's sign is a carpal spasm induced by inflating a blood pressure cuff above systolic pressure, indicating neuromuscular irritability. E) Muscle cramps result from increased neuromuscular excitability due to low calcium levels.
B) Abdominal distention is not directly associated with hypocalcemia.
D) Negative Chvostek's sign, a facial twitch in response to tapping the facial nerve, is associated with hypocalcemia, so it is incorrect.
Question 2 of 5
A nurse is assessing a client's abdomen. In what order should the nurse complete the steps of the assessment? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)
Correct Answer: D,E,C,B,A
Rationale:
To assess a client's abdomen correctly, the nurse should first observe the contours of the abdomen using a penlight (
D). This step helps to visually identify any abnormalities or distention. Next, the nurse should determine the presence of bowel sounds using the diaphragm of the stethoscope (E), as this provides information about gastrointestinal motility. Systematic percussion of the abdomen (
C) should follow, as it helps to assess for organ size and presence of fluid or air.
Then, the nurse should lightly depress the right lower quadrant of the abdomen using fingertips (
B) to check for tenderness or masses. Finally, the nurse should press deeply into the upper abdomen left of midline (
A) to detect aortic pulsations. This order ensures a thorough and systematic assessment of the abdomen. Other choices are incorrect as they do not follow a logical sequence for abdominal assessment.
Question 3 of 5
A nurse is assessing a client's cranial nerve VII. Which of the following responses should the nurse expect?
Correct Answer: C
Rationale: The correct answer is C: The client has a symmetrical smile. Cranial nerve VII, also known as the facial nerve, controls facial expression muscles. During the assessment, the nurse should expect the client to have a symmetrical smile if the nerve is functioning properly. This is because cranial nerve VII innervates the muscles responsible for facial expressions, including the muscles involved in smiling. If the smile is asymmetrical, it may indicate dysfunction of the cranial nerve VII.
Choices A, B, and D are incorrect because they do not directly relate to the assessment of cranial nerve VII. Pupillary constriction (
A) is controlled by cranial nerve II and III, tongue position (
B) is controlled by cranial nerve XII, and head turning against resistance (
D) is associated with cranial nerve XI.
Question 4 of 5
The nurse is preparing the client for surgery. Select the 3 findings that require follow-up prior to surgery.
Correct Answer: A,C,E,F
Rationale: The correct findings that require follow-up prior to surgery are dietary intake, pain level, allergies, and informed consent.
1. Dietary intake is crucial to prevent complications during surgery.
2. Monitoring pain level ensures the client's comfort and may affect postoperative pain management.
3. Allergies must be addressed to avoid adverse reactions to medications or anesthesia.
4. Informed consent is essential for legal and ethical reasons.
Blood pressure and oxygen saturation may also be important but are typically monitored during pre-operative assessments and not specifically mentioned as requiring follow-up.
Question 5 of 5
A nurse is teaching a client about stress management techniques. Which of the following client statements indicates an understanding of the teaching?
Correct Answer: B
Rationale: The correct answer is B: "I should attend a support group each week." This statement shows an understanding of the importance of seeking social support, which is a key stress management technique. Support groups provide a sense of community, understanding, and shared experiences, helping individuals cope with stress effectively.
Choice A is incorrect because inconsistent bedtime can disrupt sleep patterns, worsening stress.
Choice C is insufficient exercise for stress management.
Choice D suggests avoiding delegation, which can increase stress.