ATI RN
clinical skills exam questions Questions
Question 1 of 5
An elderly female patient has presented to the emergency department with altered mental status, hypothermia, and clinical signs of heart failure. Myxedema is suspected. Which of the following laboratory findings support this diagnosis?
Correct Answer: C
Rationale: Rationale for Correct Answer (C): Elevated T and T3/T4 levels are indicative of primary hypothyroidism, such as myxedema. In this case, the patient presents with classic symptoms of hypothyroidism, including altered mental status, hypothermia, and heart failure. Elevated T3/T4 levels confirm the diagnosis. Summary of Incorrect Choices: A: Elevated adrenocorticotropic hormone is associated with adrenal disorders, not hypothyroidism. B: Elevated cortisol levels suggest Cushing's syndrome, a condition of excess cortisol production, not hypothyroidism. D: Elevated thyroid-stimulating hormone is seen in primary hypothyroidism, but in myxedema, the issue is not with TSH but with T3/T4 levels.
Question 2 of 5
A patient with pancreatic cancer has been admitted to the critical care unit with clinical signs consistent with syndrome of inappropriate secretion of antidiuretic hormone. The nurse anticipates that clinical management of this condition will include
Correct Answer: C
Rationale: Step 1: Syndrome of inappropriate antidiuretic hormone (SIADH) leads to excess water retention, diluting sodium levels in the blood. Step 2: Fluid restriction is the mainstay of treatment to prevent further dilution of sodium. Step 3: Administering 3% normal saline (choice A) can worsen the condition by further increasing sodium levels. Step 4: Exogenous vasopressin (choice B) would exacerbate the problem by increasing water retention. Step 5: Low sodium diet (choice D) may be beneficial in the long term but is not the immediate priority.
Question 3 of 5
A patient with newly diagnosed type 1 diabetes is being transitioned from an infusion of intravenous (IV) regular insulin to an intensive insulin therapy regimen of insulin glargine and insulin aspart. How should the nurse manage this transition in insulin delivery?
Correct Answer: D
Rationale: The correct answer is D: Discontinue the IV infusion and administer the Lantus insulin at bedtime. This is the correct approach because insulin glargine (Lantus) is a long-acting basal insulin that provides a steady level of insulin throughout the day and night. By administering it at bedtime, it mimics the basal insulin secretion in a person without diabetes. This helps maintain stable blood sugar levels overnight. Choice A is incorrect because continuing the IV insulin infusion for 24 hours alongside insulin glargine is unnecessary and may lead to insulin overdose. Choice B is incorrect because discontinuing the IV infusion in several hours without administering the long-acting insulin can lead to inadequate insulin coverage. Choice C is incorrect because insulin aspart is a rapid-acting insulin that should be given with meals, not as a basal insulin replacement at bedtime.
Question 4 of 5
A college student was admitted to the emergency department after being found unconscious by a roommate. The roommate informs emergency medical personnel that the student has diabetes and has been experiencing flulike symptoms, including vomiting, since yesterday. The patient had been up all night studying for exams. The patient used the last diabetes testing supplies 3 days ago and has not had time to go to the pharmacy to refill prescription supplies. Based upon the history, which laboratory findings would be anticipated in this client? (Select all that apply.)
Correct Answer: B
Rationale: The correct answer is B: Blood glucose: 524 mg/dL. The patient likely has diabetic ketoacidosis (DKA) due to missed insulin doses, stress, and illness leading to high blood glucose levels. DKA is characterized by hyperglycemia, ketosis, and metabolic acidosis. A low blood glucose level (Choice A) is not consistent with DKA. HCO3- of 10 mEq/L (Choice C) indicates metabolic acidosis, but it's not specific to DKA. A PaCO2 of 37 mm Hg (Choice D) is within the normal range and not directly related to DKA.
Question 5 of 5
The nurse has been assigned the following patients. Which patients require assessment of blood glucose control as a nursing priority? (Select all that apply.)
Correct Answer: C
Rationale: The correct answer is C because the patient with acute pancreatitis receiving TPN is at risk for hyperglycemia due to the high glucose content in TPN. Monitoring blood glucose levels is crucial to prevent complications. Explanation for why other choices are incorrect: A: The 18-year-old male post-surgery for a fractured femur does not have a direct correlation to blood glucose control assessment. B: The 29-year-old female undergoing evaluation for pheochromocytoma is not directly related to blood glucose control assessment. D: The 62-year-old morbidly obese female post-hysterectomy for ovarian cancer does not specifically require immediate blood glucose control assessment.