ATI RN
ATI RN Custom Nursing 221 Exam 4 Questions
Extract:
Question 1 of 5
A nurse on a medical-surgical unit is caring for four clients who are 24 to 36 hr postoperative. Which of the following surgical procedures places the client at risk for deep-vein thrombosis?
Correct Answer: D
Rationale: Hip arthroplasty increases DVT risk due to prolonged immobility.
Question 2 of 5
A nurse is teaching a client who has acute kidney disease about fluid restrictions. Which of the following statements by the client should the nurse identify as understanding of the teaching?
Correct Answer: C
Rationale: Making a list of favorite beverages shows the client understands the need to prioritize fluid intake within restrictions.
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:
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 4 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 5 of 5
A nurse is caring for a client who is 2 hr postoperative following a transurethral resection of the prostate (TURP) gland. Which of the following assessments should the nurse view to be an indication of a postoperative complication?
Correct Answer: A
Rationale: Burgundy-colored urine indicates potential bleeding post-TURP.