ATI RN
RN ATI Comprehensive Assessment Exam Retake 2023 V2 Questions
Extract:
Question 1 of 5
A nurse is teaching a client who is trying to conceive. Which of the following should the nurse instruct the client to increase in her diet to prevent a neural tube defect?
Correct Answer: B
Rationale: The correct answer is B: Folate. Folate is crucial in preventing neural tube defects in a developing fetus. It helps in the formation of the neural tube, which develops into the brain and spinal cord. Adequate folate intake before and during pregnancy is essential for proper neural tube development. Calcium (
A), Iron (
C), and Zinc (
D) are important for overall health but do not specifically prevent neural tube defects. Folate supplementation is recommended for women of childbearing age to reduce the risk of neural tube defects.
Question 2 of 5
A nurse is conducting an initial assessment of a client and notices a discrepancy between the client's current IV infusion and the information received during the shift report. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Compare the current infusion with the prescription in the client's medication record. This action is essential to verify the accuracy of the IV infusion and ensure patient safety. By comparing the current infusion with the prescription in the medication record, the nurse can identify any discrepancies and take appropriate action, such as adjusting the infusion rate or notifying the healthcare provider if necessary. Contacting the charge nurse (choice
A) may be helpful but does not directly address the discrepancy. Completing an incident report (choice
B) is premature without confirming the discrepancy first. Submitting a written warning (choice
C) is not appropriate without a thorough investigation. The other choices are incomplete, and only comparing the infusion with the prescription will provide the necessary information to address the issue effectively.
Extract:
Nurses Notes
Day 1, 0900:
Client is at 31 weeks of gestation and presents with a severe headache unrelieved by acetaminophen. Client also reports urinary frequency and decreased fetal movement. Client is a G3 P2 with one preterm birth.
Day 1, 0930:
Client reports a constant and throbbing headache and rates it as a 6 on a scale of 0 to 10. Denies visual disturbances. +3 pitting edema in bilateral lower extremities, Patellar reflex 4+ without the presence of clonus. Client reports occasional nighttime leg cramps. Reports three fetal movements within the last 30 min. External fetal monitor applied with a baseline FHR 140/min with occasional accelerations and moderate variability. No uterine contractions noted
Diagnostic Results
Day 1, 1000:
Appearance cloudy (clear)
Color yellow (yellow)
pH 5.9 (4.6 to 8)
Protein 3+ (negative)
Specific gravity 1.013 (1.005 to 1.03)
Leukocyte esterase negative (negative)
Nitrites negative (negative)
Ketones negative (negative)
Crystals negative (negative)
Casts negative (negative)
Glucose trace (negative)
WBC 5 (0 to 4)
WBC casts none (none)
RBC 1 (less than or equal to 2)
RBC casts none (none)
Day 1, 1030:
CBC:
Hemoglobin 18.0 g/dL (12 to 16 g/dL)
Hematocrit 35% (37 to 47%)
Platelets 98,000/mm³ (150,000 to 400,000/mm³)
BUN 19 mg/dL (10 to 20 mg/dL)
Creatinine 0.8 mg/dL (0.5 to 1 mg/dL)
WBC 8,000/mm³ (5,000 to 10,000/mm³)
Glucose 85 mg/dL (74 to 106 mg/dL)
Liver Enzymes:
Alanine aminotransferase (ALT) 40 units/L (4 to 36 units/L)
Aspartate aminotransferase (AST) 42 units/L (0 to 35 units/L)
Total bilirubin 1.2 mg/dL (0.3 to 1 mg/dL)
Question 3 of 5
The nurse is reviewing the assessment findings. For each assessment finding, click to specify if the finding is consistent with preeclampsia or HELLP syndrome. Each finding may support more than one disease process
Correct Answer: C: Preeclampsia; A, B, D: HELLP
Rationale:
Correct Answer: C: Preeclampsia; A, B, D: HELLP
Rationale:
1. Blood pressure: Elevated blood pressure is a hallmark sign of preeclampsia due to vasoconstriction.
2. Hemoglobin (
A): Low hemoglobin levels are indicative of HELLP syndrome, a severe form of preeclampsia.
3. Alanine aminotransferase (ALT) (
B): Elevated ALT levels are associated with liver dysfunction in HELLP syndrome.
4. Platelet count (
D): Low platelet count is a characteristic finding in HELLP syndrome due to platelet aggregation.
Summary:
- Hemoglobin, ALT, and platelet count are specific to HELLP syndrome, not preeclampsia.
- Blood pressure is a key feature of preeclampsia, distinguishing it from HELLP syndrome.
Extract:
Question 4 of 5
A nurse is collecting a sputum specimen from a client who has tuberculosis. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D because sputum specimens for tuberculosis testing should be collected in the morning upon waking up. This is because sputum is most concentrated in the morning, making it easier to detect tuberculosis bacilli. Waiting 1 day for the specimen (choice
A) can delay treatment. Wearing sterile gloves (choice
B) is important for infection control but not specifically for sputum collection. Asking for 15 to 20 mL of sputum (choice
C) is appropriate, but the timing of collection is crucial.
Question 5 of 5
A nurse is caring for a client who has heart failure. Which of the following manifestations should the nurse expect?
Correct Answer: A
Rationale: The correct answer is A: Crackles in lungs. In heart failure, the heart is unable to effectively pump blood, leading to fluid accumulation in the lungs, causing crackles on auscultation due to pulmonary edema. Decreased thirst (
B) is not typical in heart failure as fluid overload often leads to increased thirst. Poor skin turgor (
C) is more indicative of dehydration. Tachycardia (
D) can occur in heart failure, but it is not specific to this condition.