ATI RN
ATI Capstone Week 9 Exam Questions
Extract:
Question 1 of 5
A nurse is assessing a client who has end-stage kidney disease and is receiving hemodialysis. Which of the following findings should the nurse identify as an indication the client is experiencing fluid overload?
Correct Answer: A
Rationale: The correct answer is A. A 5 lb weight gain in a short period indicates fluid overload in a client with end-stage kidney disease receiving hemodialysis. The excess fluid accumulates due to the kidneys' inability to filter it out effectively. This can lead to symptoms like edema, hypertension, and shortness of breath. Oxygen saturation and skin turgor are not specific indicators of fluid overload. Flattened neck veins are actually a sign of dehydration, not fluid overload.
Question 2 of 5
A nurse is caring for a client who has an acute respiratory failure (ARF). The nurse should monitor the client for which of the following manifestations of this condition? (Select all that apply.)
Correct Answer: A,B,C,E
Rationale: The correct manifestations to monitor for in a client with acute respiratory failure (ARF) are decreased level of consciousness (
A), hypercarbia (
B), severe dyspnea (
C), and tachycardia (E). 1) Decreased level of consciousness indicates poor oxygenation to the brain due to inadequate gas exchange. 2) Hypercarbia, an increased level of carbon dioxide in the blood, is a common finding in ARF as the lungs fail to adequately remove CO2. 3) Severe dyspnea is a hallmark sign of ARF, indicating the body's struggle to obtain adequate oxygen. 4) Tachycardia is the body's compensatory response to hypoxia and respiratory distress.
Choices D, F, and G are incorrect because nausea is not a typical manifestation of ARF, and options F and G are not provided.
Question 3 of 5
A nurse is monitoring a client following a thoracentesis. The nurse should identify which of the following manifestations as a complication and contact the provider immediately?
Correct Answer: C
Rationale: The correct answer is C: Increase heart rate. An increased heart rate following thoracentesis could indicate a potential complication such as a pneumothorax or hemothorax. The nurse should contact the provider immediately to assess and manage the situation promptly. Discomfort at the puncture site (
A) is common post-procedure. Decreased temperature (
B) is not typically associated with thoracentesis complications. Serosanguineous drainage from the puncture site (
D) is expected after the procedure and does not warrant immediate provider notification.
Question 4 of 5
A nurse is admitting a client who is having an exacerbation of his asthma. When reviewing the provider's orders, the nurse recognizes that clarification is needed for which of the following medications?
Correct Answer: D
Rationale: The correct answer is D: Propranolol. Propranolol is a beta-blocker, which can potentially worsen asthma symptoms by causing bronchoconstriction. It is contraindicated in asthma exacerbations. Theophylline (
A) is a bronchodilator used in asthma treatment. Montelukast (
B) is a leukotriene receptor antagonist that helps reduce inflammation in asthma. Prednisone (
C) is a corticosteroid used to decrease airway inflammation in asthma exacerbations. Propranolol (
D) is not recommended due to its potential to exacerbate asthma symptoms.
Question 5 of 5
A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and a sodium level of 123 mEq/L. Which of the following prescriptions should the nurse anticipate?
Correct Answer: B
Rationale: The correct answer is B: Restrict fluid intake to 1,000 ml per day. In SIADH, there is excessive release of ADH leading to water retention and dilutional hyponatremia. Limiting fluid intake helps prevent further water retention and dilution of sodium levels, aiming to increase serum sodium concentration. Providing a low sodium diet (choice
A) may not be sufficient to correct the low sodium level quickly. Administering desmopressin acetate (choice
C) further increases ADH release and worsens the condition. Maintaining an IV of 0.45% sodium chloride (choice
D) may lead to rapid correction of sodium levels, which can cause osmotic demyelination syndrome.