ATI RN
RN ATI Adult Medsurg Proctored Exam 2023 With NGN Questions
Extract:
Question 1 of 5
A nurse is assessing a client who has a history of type 2 diabetes mellitus. The nurse should identify which of the following findings as an indication of a microvascular complication?
Correct Answer: C
Rationale: The correct answer is C: Retinopathy. In type 2 diabetes mellitus, microvascular complications involve damage to small blood vessels. Retinopathy specifically affects the blood vessels in the retina, leading to vision problems. Peripheral neuropathy (
A) is a macrovascular complication affecting nerves. Hypertension (
B) is a common comorbidity in diabetes but not a direct microvascular complication. Stroke (
D) is a macrovascular complication involving larger blood vessels in the brain.
Therefore, the presence of retinopathy is a clear indication of a microvascular complication in a client with type 2 diabetes mellitus.
Question 2 of 5
A nurse is planning care for a client who had a lumbar laminectomy. Which of the following interventions should the nurse include in the plan of care?
Correct Answer: B
Rationale: The correct answer is B: Turn the client by log rolling with a turning sheet. This is the correct intervention because after a lumbar laminectomy, it is crucial to protect the surgical site and avoid bending or twisting the spine. Log rolling with a turning sheet helps maintain proper alignment and prevent injury to the surgical area.
Choice A is incorrect because encouraging the client to ambulate independently may put stress on the surgical area.
Choice C is incorrect as positioning the client in a high Fowler's position may also strain the spine.
Choice D is incorrect because applying a heating pad to the lower back can increase the risk of burns and should be avoided near a surgical site.
Question 3 of 5
A nurse is teaching a client how to obtain a specimen at home for a fecal occult blood test. Which of the following actions should the nurse instruct the client to take for 3 days prior to collecting the specimen?
Correct Answer: A
Rationale: The correct answer is A: Avoid eating red meat. Red meat can cause false positives in fecal occult blood tests due to the presence of heme iron which can be mistaken for blood. Instructing the client to avoid red meat for 3 days prior to collecting the specimen helps to ensure the accuracy of the test results.
Summary:
B: Increasing fiber intake does not directly impact the accuracy of the fecal occult blood test.
C: Taking an iron supplement can interfere with the test results by increasing the amount of iron in the stool, leading to false positives.
D: Drinking grapefruit juice is not relevant to the accuracy of the fecal occult blood test.
Question 4 of 5
A nurse is caring for a client immediately following intubation with an endotracheal (ET) tube. Which of the following methods should the nurse identify as the most reliable for verifying placement of the ET tube?
Correct Answer: C
Rationale: The correct answer is C: Using an end-tidal CO2 detector. This method is the most reliable for verifying ET tube placement because it directly measures the presence of CO2 in exhaled breath, confirming that the tube is in the trachea. This is crucial to prevent inadvertent esophageal intubation. Observing for symmetrical chest rise and fall (
A) can be misleading as it can occur even with esophageal intubation. Auscultating bilateral breath sounds (
B) can also be unreliable as breath sounds may be heard even if the tube is in the esophagus. Checking for condensation in the ET tube (
D) is not a reliable method for verifying placement as condensation can occur regardless of tube placement.
Question 5 of 5
A nurse notes that a clients eyes are protruding slightly from their orbits. Which of the following laboratory findings should the nurse expect?
Correct Answer: B
Rationale: The nurse should expect increased T4 levels in a client with slightly protruding eyes, known as exophthalmos, as it is a classic sign of hyperthyroidism, where the thyroid gland is overactive. Thyroid hormones, such as T4, are responsible for regulating metabolism, and elevated levels can lead to symptoms like exophthalmos. Decreased TSH levels (choice
A) would actually be seen in primary hyperthyroidism due to negative feedback. Elevated calcium levels (choice
C) are more indicative of hyperparathyroidism. Low hemoglobin levels (choice
D) are not typically associated with exophthalmos or hyperthyroidism.