ATI RN
ATI Capstone Week 9 Exam Questions
Extract:
Nurses' Notes
Day 1:
1000:
Client alert and oriented x3. Lung fields clear, heart rhythm regular bowel sounds normoactive x4; ate 75% of morning meal. Denies pain. Left forearm arteriovenous (AV) fistula, skin warm, brachial and radial pulses 2+
1600:
Client returned from dialysis, lethargic, not hungry, tried to eat a few crackers but vomited them up. Capillary blood glucose 134 mg/dL. AV fistula site skin warm, bruit and thrill noted, brachial and radial pulses palpable.
Day 2:
0700:
Client reports not sleeping well last night; capillary blood glucose 75 mg/dL; crackles in left lower lobe: unproductive cough: AV fistula site ecchymotic, warm, bruit and thrill noted. Oriented to person, place, and time.
A nurse is caring for a client receiving hemodialysis.
Vital Signs
Nurses' NotesVital SignsMedical History
Day 1:
1000:
Temperature 36.3°C (97.3°F)
Heart rate 70/min
Respiratory rate 16/min
Blood pressure 144/72 mm Hg
Oxygen saturation 94% on room air
Weight 90 kg (198 lb)
1600:
Temperature 37.1 °C (98.7°F)
Heart rate 62/min
Respiratory rate 16/min
Blood pressure 112/54 mm Hg
Oxygen saturation 95% on room air
Day 2:
0700:
Temperature 36.7°C (98.1°F)
Heart rate 62/min
Respiratory rate 12/min
Blood pressure 118/52 mmHg
Oxygen saturation 95% on room air
Weight 86.4 kg (190)
A nurse is caring for a client receiving hemodialysis.
Medical History
Nurses' NotesVital SignsMedical History
Client has a history of type 2 diabetes mellitus, and hemodialysis with Arteriovenous fistula.
A nurse is caring for a client receiving hemodialysis.
Question 1 of 5
A nurse is caring for a client who has received hemodialysis. Which of the following assessment findings require follow-up?
Correct Answer: B,E,F
Rationale: Weight loss of 3.6 kg post-dialysis needs monitoring for dehydration. Crackles and cough suggest fluid overload or pulmonary edema. Ecchymosis and warmth at the AV fistula site may indicate infection or trauma. Vital signs, glucose, and bruit/thrill are stable.
Extract:
Question 2 of 5
A nurse is caring for a client who has type 2 diabetes mellitus and notes the client is declining. Which of the following would indicate the client is in a hyperosmolar hyperglycemic state (HHS)?
Correct Answer: D
Rationale: A glucose level of 650 mg/dL indicates HHS, characterized by extreme hyperglycemia without significant ketosis. Hypertension, fruity breath, and ketosis are more typical of DKA.
Question 3 of 5
A nurse is assessing a client who has hypothyroidism. The nurse should expect which of the following findings?
Correct Answer: B
Rationale: Weight gain is common in hypothyroidism due to slowed metabolism. Exophthalmos, diaphoresis, and palpitations are associated with hyperthyroidism.
Question 4 of 5
A nurse is assessing a client who has a pneumothorax with a chest tube in place. For which of the following findings should the nurse notify the provider?
Correct Answer: B
Rationale: Tracheal deviation to the unaffected side indicates tension pneumothorax, a life-threatening condition. Bubbling, scant drainage, and crepitus are less urgent.
Question 5 of 5
A nurse is teaching about disease management for a client who has type 1 diabetes mellitus. Which statement made by the client indicates an understanding of the teaching?
Correct Answer: A
Rationale: Abdominal insulin injections ensure consistent absorption. Post-meal glucose checks, unrestricted ice cream, and weight loss causing hypoglycemia are incorrect.