ATI RN
ATI Medsurg Proctored Final Exam Questions
Extract:
Question 1 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 2 of 5
A nurse at a rehabilitation center is planning care for a client who had a left hemispheric cerebrovascular accident (CVA) 3 weeks ago. Which of the following goals should the nurse include in the client's rehabilitation program?
Correct Answer: A
Rationale: The correct answer is A: Establish the ability to communicate effectively. For a client who had a left hemispheric CVA, the left hemisphere is responsible for language and speech functions.
Therefore, focusing on establishing effective communication is crucial in the rehabilitation program. It targets the specific deficits caused by the CVA and aims to improve the client's quality of life. Increasing mobility to a normal level (
B) is important but may not be the priority in this case. Promoting independent living without assistance (
C) is a broad goal that may encompass various aspects beyond communication. Restoring full visual function (
D) is not directly related to a left hemispheric CVA.
Question 3 of 5
A nurse is caring for a client receiving TPN. What action should the nurse take?
Correct Answer: B
Rationale: The correct answer is B: Check the client's capillary blood glucose level every 4 hr. This is crucial because TPN can cause hyperglycemia due to its high glucose content. Monitoring blood glucose levels helps in detecting and managing hyperglycemia.
Incorrect answers:
A: Monitoring serum sodium levels is not directly related to TPN administration.
C: Administering the solution at room temperature is not necessary for TPN administration.
D: Discontinuing TPN abruptly can lead to serious complications; it should be gradually tapered off.
Overall, monitoring blood glucose levels is essential in TPN therapy to prevent complications related to hyperglycemia.
Question 4 of 5
A nurse is reviewing the EKG strip of a client who has prolonged vomiting. Which of the following abnormalities on the client's EKG should the nurse interpret as a sign of hypokalemia?
Correct Answer: A
Rationale: The correct answer is A: Abnormally prominent U wave. In hypokalemia, low potassium levels can lead to U wave prominence on an EKG. The U wave becomes more visible and prominent due to delayed repolarization of the Purkinje fibers. This is a classic EKG finding in hypokalemia. Tachycardia (choice
B) is a non-specific finding and can be caused by various conditions. Flattened P wave (choice
C) is seen in hyperkalemia, not hypokalemia. Prolonged PR interval (choice
D) is more indicative of first-degree heart block or other conduction abnormalities, not specifically hypokalemia.
Question 5 of 5
A client is receiving treatment for stage IV ovarian cancer and asks the nurse to discuss her prognosis. The client plans to have aggressive surgical, radiation, and chemotherapy treatments. Which of the following prognoses should the nurse discuss with the client?
Correct Answer: A
Rationale: The correct answer is A: Poor. In stage IV ovarian cancer, the cancer has spread beyond the ovaries to distant organs, resulting in a poor prognosis. The aggressive treatments may help manage symptoms and prolong survival but the overall prognosis remains poor due to the advanced stage of the cancer.
Choice B (Favorable) is incorrect because stage IV ovarian cancer has a poor prognosis.
Choice C (Uncertain) is incorrect as the prognosis for stage IV ovarian cancer is generally known to be poor.
Choice D (Excellent) is incorrect as stage IV ovarian cancer is not associated with an excellent prognosis due to its advanced stage.