ATI RN
ATI Comprehensive 2023 With NGN 180 Questions And Answers Questions
Extract:
A nurse is caring for a 75-year-old client who is admitted to the medical-surgical unit
Nurses' Notes
Today
0700:
Received change of shift report. Client is 2 days postoperative following a hysterectomy and
they have not yet ambulated with physical therapy due to significant postoperative pain. Per
change of shift report, pain medications have been adjusted and pain has improved. Client
currently reports pain level as 2 on a scale of 0 to 10.
0900:
Ambulating in hallway with the assistance of physical therapy.
1000:
Return to bed with siderails up x 2, but not wearing sequential compression devices because they
"hurt too much." Applied antiembolism stockings.
1400:
Client notified nurse that right leg is warm and painful. Assessment reveals unilateral right lower
extremity swelling and warmth below the knee. Provider notified.
Laboratory Results
Today
1430:
WBC count 10,500/mm³ (5,000 to 10,000/mm³)
Hgb 11.1 g/dL (12 to 16 g/dL)
Hct 34% (37% to 47%6)
Platelet count 250,000/mm³ (150,000 to 400,000/mm³)
Coagulation studies:
PT 11.5 seconds (11 to 12.5 seconds)
INR 0.9 (0.8 to 1.1)
History and Physical
3 days ago:
Past medical history: Type 2 diabetes mellitus, hypertension
Surgical history: Cesarean birth x 2 as a young adult
Social history: Has smoked 1 pack of cigarettes per day for 4 years, drinks socially, does not
exercise.
Weight: 121,3 kg (267.4 lb)
Vital Signs
Today
0800
Temperature 37° C (98.6" F)
Heart rate 97/min
Respiratory rate 18/min
BP 138/78 mm Hg
Question 1 of 5
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing.
Correct Answer: C
Rationale: Unilateral swelling and warmth suggest deep vein thrombosis (DVT), requiring assessment for ischemia.
Extract:
A nurse is caring for a client who is alert and oriented and is receiving continuous ECG monitoring. The cardiac rhythm strips shows a wavy baseline, no distinguishable P waves, and an increased heart rate.
Question 2 of 5
The nurse should identify the cardiac rhythm as which of the following?
Correct Answer: D
Rationale: The correct answer is D: Atrial fibrillation. The nurse should identify the cardiac rhythm as atrial fibrillation because it is characterized by irregular, rapid electrical activity in the atria leading to an irregular, fast heart rate. This can result in poor blood flow and increase the risk of stroke. Ventricular asystole (
A) is the absence of ventricular electrical activity, second-degree heart block (
B) is a conduction disorder where some electrical signals from the atria do not reach the ventricles, and sinus tachycardia (
C) is a fast but regular heart rate originating from the sinus node. These options are incorrect as they do not match the characteristics of atrial fibrillation.
Extract:
A nurse is caring for a newborn.
Nurses' Notes
0640:
Weight 4200 gm (9 lb 4 oz), head circumference 35.5 cm (14 in)
Respiratory rate 68/min, with mild grunting.
0650:
Respiratory rate 72/min, with mild grunting
0700:
Respiratory rate 76/min, with moderate grunting and mild intercostal retractions.
Question 3 of 5
The client is at risk for developing------- and----
Correct Answer: B,D
Rationale: Transient tachypnea and hypopycemia are common risks in newborns with respiratory distress.
Extract:
A nurse in a family health clinic is caring for a client who requests information regarding the correct use of condoms.
Question 4 of 5
Which of the following statements should the nurse make?
Correct Answer: A
Rationale: The correct answer is A because it emphasizes the importance of using condoms in addition to implanted contraceptive methods to prevent STDs. This is crucial for dual protection.
Choice B is incorrect as petroleum-based lubricants can damage condoms.
Choice C is incorrect as condoms should not be tight to avoid breakage.
Choice D is incorrect as condoms are more effective for birth control when used with spermicides.
Extract:
A nurse is preparing a client for transfer to a long-term care rehabilitation facility following a below-the-knee amputation.
Question 5 of 5
Which action should the nurse take to protect the client's confidentiality?
Correct Answer: E
Rationale: Secure communication ensures confidentiality during transfers.