ATI RN
ATI Comprehensive 2023 With NGN 180 Questions And Answers Questions
Extract:
A nurse in an antepartum unit is caring for a client.
Nurses' Notes
2000:
Client is 38-year-old, G4 P3 at 38 weeks of gestation. Presents for evaluation of labor and
spontaneous rupture of membranes (SROM). Client states, "My water broke a couple of hours
ago and is a greenish color." Client also reports contractions began about 4 hr ago and have
become consistently stronger and closer together.
Electronic fetal monitor applied. Small amount of thin green fluid noted on perineal pad.
Contraction palpated, lasted 40 seconds, moderate in intensity. Fetal heart rate (FHR) 165/min.
Vaginal examination performed: cervix 4 cm dilated, 70% effaced, 0 station, vertex presentation.
Client reports a history of chronic hypertension that has been well-controlled during this
pregnancy. Also, states were diagnosed with gestational diabetes at 28 weeks of gestation.
Vital Signs
2000:
Temperature 36.7° C (98.1° F)
Heart rate 98/min
Respiratory rate 20/min
Blood pressure 128/84 mm Hg
Oxygen saturation 98% on room air
Question 1 of 5
Select the 2 findings that require immediate follow-up.
Correct Answer: C,E
Rationale: An elevated fetal heart rate and meconium-stained amniotic fluid indicate potential distress, necessitating urgent intervention.
Extract:
The nurse is continuing to care for the child
Diagnostic Results
1100:
X-ray of right arm: nondisplaced fracture of radius and ulna at the midpoint.
Assessment
1000:
Child is alert and appears developmentally appropriate for their age and well nourished.
Respirations easy and unlabored. Abdomen nondistended. Right forearm and fingers are
edematous. Ecchymotic area noted on outer aspect of the forearm. Radial pulse +2. Fingers
slightly cool to touch. Child can move fingers and reports a mild "tingling" sensation. Child
verbalizes a pain level of 4 on a scale of 0 to 10. Abrasion noted on right knee. No active
bleeding. Multiple areas of bruising noted on lower extremities in various stages of healing
1145:
Edema in right forearm and fingers is mildly increased. Child states that mild tingling in fingers
is unchanged. Able to move all fingers equally. Radial pulse is equal in both extremities, Right
hand fingers are slightly cooler than left hand fingers.
Question 2 of 5
Select the 3 priority actions that the nurse should take.
Correct Answer: B,C,F
Rationale: Administering pain relief, protecting the abrasion, and elevating the limb reduce swelling and promote comfort.
Extract:
The nurse is discussing discharge plans with an older adult client who lives alone and has left sided weakness following a stroke
Question 3 of 5
Which of the following information is the priority for the nurse to discuss?
Correct Answer: B
Rationale: The correct answer is B because obtaining an alert system for help in case of a fall is the priority. This is crucial for immediate assistance and safety in case of emergencies. Discussing support groups (
A) can be beneficial but is not as urgent. Providing transportation resources (
C) and choosing a home physical therapy agency (
D) are important but not immediate priorities compared to ensuring immediate help in case of a fall.
Extract:
A nurse is creating a plan of care for a client who has paranoid personality disorder and refuses to take their medication.
Question 4 of 5
Which of the following interventions should the nurse include in the plan?
Correct Answer: A
Rationale: The correct answer is A: Speak in a neutral tone when addressing the client. This intervention is important as it helps maintain a calm and non-confrontational communication approach, which is crucial when interacting with clients experiencing delusions. Speaking in a neutral tone can prevent escalating the client's anxiety or paranoia, promoting a more open and effective dialogue.
Choice B is incorrect as forcing the client to take medication can lead to resistance and further exacerbate trust issues.
Choice C is incorrect as encouraging the client to discuss their delusions without a neutral tone may reinforce the delusions rather than help the client gain insight.
Choice D is incorrect as using humor may not be appropriate or effective in addressing the client's delusions and could potentially be perceived as insensitive.
Extract:
A nurse is preparing to administer dopamine hydrochloride 4mcg/kg/min via continuous infusion. Available is dopamine hydrochloride in a solution of 800 milligrams in a 250ML bag. The client weighs 80 kilograms.
Question 5 of 5
The nurse should set the IV infusion to deliver how many ml/hr?
Correct Answer: B
Rationale: The correct answer is B: 11.0 mL/hr.
To calculate the IV infusion rate, you need to consider the total volume to be infused and the time frame. In this case, if the total volume to be infused is 66 mL over 6 hours, you divide 66 mL by 6 hours to get 11.0 mL/hr.
Choice A does not provide a specific rate.
Choices C and D are incorrect because they do not match the calculated rate based on the given information.