ATI RN
Introduction to Nursing Pdf Questions
Question 1 of 5
The nurse is reviewing the report of a client's routine urinalysis. Which value should the nurse consider abnormal?
Correct Answer: B
Rationale: The correct answer is B: Urine pH of 3.0 is abnormal. Normal urine pH ranges from 4.6 to 8.0. A pH of 3.0 indicates highly acidic urine, which may be indicative of certain health conditions. Specific gravity of 1.03 is within the normal range (1.005-1.030). Absence of protein and glucose in urine is normal. Proteinuria and glucosuria are typically abnormal findings.
Question 2 of 5
The nurse is caring for a client who has fluid overload. What action by the nurse takes priority?
Correct Answer: A
Rationale: The correct answer is A: Administer high-ceiling (loop) diuretics. In fluid overload, loop diuretics help the body eliminate excess fluid rapidly, which is a priority intervention. Assessing lung sounds (B) is important but not as urgent as addressing the fluid overload. Placing a pressure-relieving overlay (C) is not directly related to managing fluid overload. Weighing the client daily (D) is important for monitoring fluid status but does not address the immediate need for fluid removal.
Question 3 of 5
A nurse assesses clients at a family practice clinic for risk factors that could lead to dehydration. Which client is at greatest risk for dehydration?
Correct Answer: C
Rationale: The correct answer is C, the 76-year-old who is cognitively impaired, is at the greatest risk for dehydration. Cognitive impairment can impact one's ability to recognize thirst cues or communicate their need for fluids. This client may forget to drink water or be unable to express their thirst, leading to dehydration. The other choices are less likely at risk for dehydration because: A) Long-term steroid therapy can increase thirst and fluid intake, B) Recent IV fluids indicate recent hydration, D) Congestive heart failure may lead to fluid retention rather than dehydration.
Question 4 of 5
A patient is receiving thrombolytic therapy, and the nurse monitors the patient for adverse effects. What is the most common undesirable effect of thrombolytic therapy?
Correct Answer: D
Rationale: The correct answer is D: Internal and superficial bleeding. Thrombolytic therapy works by breaking down blood clots, which can lead to bleeding as a side effect. This is the most common undesirable effect because it is directly related to the mechanism of action of thrombolytic agents. Dysrhythmias (choice A), although possible, are less common and not directly related to the drug's action. Nausea and vomiting (choice B) are general side effects that are not specific to thrombolytic therapy. Anaphylactic reactions (choice C) are rare but serious adverse effects that can occur with any medication, not just thrombolytics.
Question 5 of 5
What finding should the nurse expect during the assessment of a young adult with infective endocarditis (IE)?
Correct Answer: B
Rationale: The correct answer is B: A new regurgitant murmur. In infective endocarditis, vegetation on heart valves can cause valve dysfunction, leading to new regurgitant murmurs. This is a classic finding in IE assessment. Substernal chest pressure (A) is more common in conditions like angina or myocardial infarction. Pruritic rash on the chest (C) is not typically associated with IE. Involuntary muscle movement (D) is not a common finding in IE and is more suggestive of neurological conditions.