ATI RN
ATI Medsurg Proctored Final Exam Questions
Extract:
Question 1 of 5
A nurse is assessing a client who has fluid overload. Which of the following findings shouldn't the nurse expect?
Correct Answer: D
Rationale: The correct answer is D: Increased hematocrit. In fluid overload, there is an excess of fluid in the body, leading to dilution of blood components including hematocrit.
Therefore, an increased hematocrit would not be expected. Increased heart rate (
A), blood pressure (
B), and respiratory rate (
C) are all common findings in fluid overload due to the body's compensatory mechanisms to maintain adequate perfusion. Thus, these findings are expected.
Question 2 of 5
A nurse is caring for a client who has HIV. Which of the following laboratory values is the nurse's priority?
Correct Answer: C
Rationale: The correct answer is C: CD4-T-cell count 180 cells/mm3. In HIV care, monitoring the CD4-T-cell count is crucial as it reflects the immune system's ability to fight infections. A low CD4 count indicates a weakened immune system, increasing the client's susceptibility to opportunistic infections. This value guides treatment decisions, such as initiating antiretroviral therapy. The other options, while important, do not directly reflect the client's immune status in the context of HIV. Hemoglobin and platelet counts are relevant for assessing anemia and clotting function, respectively. White blood cell count is a general indicator of infection or inflammation. Prioritizing CD4-T-cell count ensures appropriate management of HIV and prevention of complications.
Question 3 of 5
A nurse is completing discharge teaching with a client following arthroscopic knee surgery. Which of the following instructions should the nurse include in the teaching?
Correct Answer: C
Rationale: The correct answer is C: Apply ice to the affected area. Ice application helps reduce swelling and pain post-surgery. Keeping the knee elevated above the heart (
A) is important, but not at all times as it can lead to other issues like blood pooling. Avoiding physical therapy for 2 weeks (
B) is incorrect as early mobilization is crucial for recovery. Limiting fluid intake (
D) is not recommended as hydration is essential for healing.
Question 4 of 5
A nurse is planning care for a client with a T4 spinal cord injury at risk for UTIs. What should be included?
Correct Answer: B
Rationale: The correct answer is B: Encourage fluid intake at and between meals. This is because increasing fluid intake helps to flush out bacteria from the urinary tract, reducing the risk of UTIs. Limiting fluid intake (choice
A) can lead to concentrated urine, making it easier for bacteria to multiply. Restricting acidic foods (choice
C) does not directly impact the risk of UTIs. Using an indwelling catheter continuously (choice
D) actually increases the risk of UTIs due to the constant presence of a foreign body in the urinary tract. Encouraging fluid intake at and between meals is the most effective way to prevent UTIs in clients with spinal cord injuries.
Question 5 of 5
A nurse is caring for a client who is receiving cisplatin to treat bladder cancer. After several treatments, the client reports fatigue. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Check the results of the client's most recent CBC. Fatigue is a common side effect of cisplatin, which can cause bone marrow suppression leading to anemia. Checking the CBC will help determine if the client is experiencing anemia, which can be managed with appropriate interventions. Administering a blood transfusion (
B) should not be done without confirming the need through lab results. Offering a stimulant medication (
C) may mask the underlying cause of fatigue. Advising the client to reduce physical activity (
D) may not address the root cause of the fatigue.