ATI RN
ATI RN Custom Nursing 221 Exam 4 Questions
Extract:
Question 1 of 5
A nurse is caring for a client who has a new diagnosis of urolithiasis. Which of the following should the nurse identify as an associated risk factor?
Correct Answer: A
Rationale: Family history is a well-known risk factor for urolithiasis due to genetic predispositions.
Extract:
Diagnostic Results
Admission: 12 hr later.
• Lithium level 1.8 mEq/L (less than 1.5 mEq/L).
• Glucose level 90 mg/dL (74 to 106 mg/dL).
• Sodium 133 mEq/L (135 to 145 mEq/L).
• Lithium level 1.2 mEq/L (less than 1.5 mEq/L).
• Glucose level 80 mg/dL (74 to 106 mg/dL).
• Sodium 134 mEq/L (135 to 145 mEq/L).
Vital Signs
Admission:
• Temperature 37.7° C (99.9° F).
• Respiratory rate 18/min.
• Pulse rate 84/min.
• BP 130/84 mm Hg.
12 hr later:
• Temperature 37° C (98.6° F).
• Respiratory rate 16/min.
• Pulse rate 96/min.
• BP 88/50 mm Hg.
Nurses Notes
Admission:
• Gastrointestinal upset.
• Uncoordinated gait.
12 hr later:
• Client fell asleep during assessment.
• Client reports blurred vision.
• Pale, dry mucous membranes.
• Urine output 40 mL/hr.
Question 2 of 5
A nurse is collecting data from the client 12 hr later. How should the nurse interpret the following findings? For each potential finding, click to specify whether the finding is an indication of potential improvement or an indication of potential worsening condition.
Correct Answer: A: Potential Worsening, B: Potential Improvement, C: Potential Improvement, D: Potential Worsening, E: Potential Worsening
Rationale: A: Blurred vision indicates potential neurotoxicity. B: Lithium level decrease to 1.2 mEq/L shows improvement. C: Urine output of 40 mL/hr is adequate. D: Pale, dry mucous membranes suggest dehydration. E: Hypotension (88/50 mm Hg) indicates worsening.
Extract:
Question 3 of 5
A nurse suspects that a client admitted for treatment of bacterial meningitis is experiencing increased intracranial pressure (ICP). Which of the following assessment findings by the nurse supports this suspicion?
Correct Answer: D
Rationale: Restlessness can indicate increased ICP due to changes in mental status.
Extract:
Nurses' Notes
0800: Client is 3 days postoperative.
Currently disoriented to time and place, oriented to self.
Client is displaying disorganized thinking, a lack of attention when spoken to, and rambling speech that is incoherent at times.
Client attempts to get out of bed without assistance.
Changes in client's behavior began the prior evening, and the client has been awake most of the night.
Client has refused to eat or drink since the previous day.
Intake and output from the previous day: 250 mL intake, 2,500 mL output.
A call placed to the provider to report findings.
0830: IV fluids initiated by RN. Urine and blood samples collected per the provider's prescription.
The client continues to be restless.
Vital Signs
• Heart rate 115/min
• Respiratory rate 20/min
• BP 90/65 mm Hg
• Temperature 38.6°C (101.5°F)
Question 4 of 5
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to collect data about the client's progress.
Action to Take
Potential Condition
Parameter to Monitor
Correct Answer: C, D, E, B, E
Rationale: Condition: Delirium due to acute confusion and fever. Actions: Monitor fluid intake/output for dehydration; encourage family presence for reorientation. Parameters: Sleep-wake cycle and fall risk to assess delirium and safety.
Extract:
Question 5 of 5
A nurse is assessing a client who reports numbness and pain in his right palm, index finger, and middle finger. The client reports working with a keyboard most of the time while at work. The nurse suspects carpal tunnel syndrome. Which of the following tests should the nurse request that the client perform?
Correct Answer: C
Rationale: Holding the wrist at a 90-degree flexion (Phalen's test) is a diagnostic test for carpal tunnel syndrome.