ATI RN
ATI Advanced Med Surg Cohort 4 Exam Questions
Extract:
Admission Assessment
Today:
0800:
The client states, "I got admitted because they said I have a really bad UTI."
The client reports dysuria for "about three days." The client developed fever this morning, so
they came to the emergency department to be evaluated. The client was found to have a urinary tract infection and was admitted for further care. They state they are still having bladder discomfort, but reports no other manifestations.
Medical history Hypertension, atrial fibrillation
Current Medications lisinopril 40mg PO daily, warfarin 2.5 mg PO daily
The client is in no acute distress. Oropharynx clear, mucous membranes moist, breath sounds clear bilaterally. Heart rate with regular rhythm and no murmur. CN II-XII intact, no weakness.
Nurses' Notes
Today:
0900:
The nurse is called to the client's room. The client reports headache with pain of 4 on a pain scale of 0 to 10 as throbbing. "I think my fever is better, but my head is killing me. Can I have something stronger for pain?"
0945:
The nurse is called again to the client's room. The client states, "You've got to help, something is wrong; this is the worst headache of my life." Client also reports ringing in the ears, photophobia, and left-sided weakness. They deny facial pain .
Client crying aphasia observed; oropharynx clear, mucous membranes moist, loss of peripheral vision. Breath sounds clear bilaterally; heart rate with regular rate, no murmur; negative Kernig and Brudzinski sign, left-sided upper and lower extremity weakness.
Provider Prescriptions
Today:
0800:
Acetaminophen 650mg PO every 8 hr PRN fever greater than 38˚C (100.4˚F) Hydrocodone/Ibuprofen 7.5/200 mg PO every 8 hr PRN pain
Lisinopril 40mg PO daily Warfarin 2.5 mg PO daily
Ciprofloxacin 500 mg PO BID x 7 days
Laboratory Results
Today:
0800:
WBC 11,000 mm3 (5,000 to 10,00mm3)
Urinalysis
Appearance clear
Color dark amber
pH 6 (4.6 to 8)
Protein 2 mg/dL (0 to 8 mg/dL)
Leukocyte esterase positive
Nitrites positive
Ketones none
Bilirubin none
Blood positive
INR: 4.9 (0.8 to 1.1)
Vital Sign
Today:
0800:
Temperature 38.1˚C (100.5˚F)
Heart Rate 89/min
Respiratory Rate 19/min
Blood Pressure 119/85 mmHg
SaO2 98% on room air
0930:
Temperature 37.2˚C (98.9˚F)
Heart Rate 62/min
Respiratory Rate 19/min
Blood Pressure 159/83 mmHg
SaO2 93% on room air
Medication Administration Record
0800:
Acetaminophen 650 mg PO 0900:
Hydrocodone/Ibuprofen 7.5/200 mg PO
Question 1 of 5
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
Correct Answer: B (Hemorrhagic Stroke), A (Prepare for STAT CT, Seizure precautions), C (Temperature, PT/INR)
Rationale: Sudden severe headache, neurological symptoms, and elevated INR suggest hemorrhagic stroke, requiring urgent CT and seizure precautions, with monitoring of temperature and PT/INR.
Extract:
Question 2 of 5
A patient with paraplegia resulting from a T9 spinal cord injury has a neurogenic reflexic bladder. Which action should the nurse include in the plan of care?
Correct Answer: B
Rationale: Self-catheterization promotes independence and reduces infection risk, making it the preferred method for managing neurogenic bladder in spinal cord injury.
Question 3 of 5
A nurse is assessing a client who has meningitis and notes when passively flexing the client's neck there is an involuntary flexion of both legs. Which of the following conditions is the client displaying?
Correct Answer: D
Rationale: Brudzinski's sign is characterized by involuntary flexion of the hips and knees when the neck is passively flexed, indicating meningeal irritation commonly seen in meningitis.
Extract:
Nurses' Notes
Client admitted to the emergency department with a 2-day history of lethargy, nausea, vomiting, anorexia, headache, and general muscle aches. The client reports diarrhea, abdominal pain, and a sore throat. Pupils are 3 mm, equal and reactive to light. Intermittent nystagmus noted. Client reports sensitivity to light.
Client is lethargic, but arouses easily and is oriented to person, place, and time. Hand grasps are strong and equal bilaterally.
Bilateral breath sounds are clear and present throughout. Apical pulse is regular.
Skin is warm and dry. Pinpoint, red, macular rash noted on upper chest. Abdomen is distended, bowel sounds are present in 4 quadrants.
Vital Signs
Temperature 38.9° C (102° F)
Blood pressure 168/80 mm Hg
Heart rate 118/min
Respiratory rate 24/min
Oxygen saturation 95% on room air
Question 4 of 5
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
Correct Answer: B (Meningitis), A (Seizure precautions, Dim lights), C (Neurologic status, Temperature)
Rationale: Symptoms like headache, photophobia, and rash suggest meningitis, requiring seizure precautions and light reduction, with monitoring of neurologic status and temperature.
Extract:
Question 5 of 5
A nurse is caring for a client who has right-sided acoustic neuroma resulting in impairment of cranial nerves IX and X. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: Impairment of cranial nerves IX and X increases aspiration risk due to impaired swallowing and gag reflex, necessitating suction equipment.