ATI RN
ATI Comprehensive 2023 With NGN 180 Questions And Answers Questions
Extract:
A nurse caring for a client in the outpatient mental health clinic
Vital signs
2 months ago:
BP 128/78 mm Hg
Heart rate 76/min
Respiratory rate 17/min
Today
BP 169/91 mm HG
Heart rate 78/min
Respiratory rate 18/min
Nurses' Notes
Today
Client states, "I'm feeling much better." They report less fatigue, even though they have
difficulty sleeping. Client reports they are not sad anymore but are experiencing more frequent
headaches. Client continues to deny any suicidal ideation.
Question 1 of 5
Select the findings that indicate the client is experiencing adverse effects of the medication.
Correct Answer: B,D
Rationale: Hypertension and difficulty sleeping are potential side effects of certain medications.
Extract:
A nurse is caring for a client in active labor.
Admission Assessment
0200:
Gravida 1, Para 0 at 39 weeks gestation. Presents with contractions occurring every 5 to 6 min,
45 to 60 seconds duration. Cervical examination 4 cm dilated, 50% effaced. Admit to labor and
delivery unit.
Nurses' Notes
0200:
Admitted to labor and delivery unit, reports pain as 7 on a scale of 0 to 10 with contractions.
Cervix 4 cm dilated, 50% effaced, with membranes intact.
0230:
Client reports increasing discomfort with contractions. Cervix 5 cm dilated, 60% effaced, with
membranes intact. Contractions occurring every 5 min, 45 to 60 seconds duration.
0300:
Epidural anesthesia initiated, Cervix 7 cm dilated, 70% effaced, with membranes intact.
Contractions occurring every 4 to 5 min. 60 seconds duration,
Vital Signs
0200:
Temperature 36.9° C (98.4° F)
Heart rate 86/min
Respiratory rate 18/min
BP 118/78 mm Hg
0230:
Temperature 37° C (98.6° F)
Heart rate 88/min
Respiratory rate 20/min
BP 120/80 mm Hg
0300:
Temperature 37.1°C?98.8°F?
Heart rate 90/min
Respiratory rate 18/min
BP 122/76 mm Hg
The nurse is assuming care for the client at 0305.
Question 2 of 5
For each nursing action, click to specify if the nursing action is essential or contraindicated for the client.
| Nursing Action | Essential | Contraindicated |
|---|---|---|
| Assist the client with ambulation | ||
| Inform the client to expect drowsiness | ||
| Monitor for elevated temperature | ||
| Assess for urinary retention | ||
| Encourage the client to turn from side to side |
Correct Answer: C,D,E
Rationale: Monitoring temperature, assessing urinary retention, and encouraging position changes are essential after epidural administration.
Extract:
A nurse is caring for a client
Nurses: Notes
0800:
A client who has bipolar disorder is admitted to the inpatient psychiatric unit. During the
morning assessment, the client reports blurred vision and an increase in urine output. it's noted
that the client is having clonic jerking of upper extremities: Provider notified and laboratory tests
ordered. Skin is warm and dry without rash.
Complete the following sentence by using the list of options.
Question 3 of 5
The nurse understands that the patient has likely developed lithium toxicity and will be monitored for-------
Correct Answer: B
Rationale: The correct answer is B: seizure activity. Lithium toxicity can lead to neurological symptoms including seizures. Monitoring for seizure activity is crucial to prevent serious complications. Blood glucose levels (
A) are not typically affected by lithium toxicity. Symptoms of infection (
C) are unrelated to lithium toxicity. Monitoring temperature (
D) is important but not specific to lithium toxicity.
Extract:
A nurse is preparing to initiate intravenous fluids via pump for a client.
Question 4 of 5
which of the following actions should the nurse take?
Correct Answer: B
Rationale: The nurse should choose option B: Ensure the IV tubing is primed and free of air bubbles before connecting it to the client. This is crucial to prevent air embolism, which can be life-threatening. Priming the tubing ensures that only fluid is infused into the client's bloodstream. Air bubbles can travel to the heart and lungs, causing blockages and impairing circulation. Positioning the IV pump below the client's heart (option
C) is incorrect as it can lead to rapid infusion and potential complications. Selecting a catheter gauge of 12 (option
D) is not always necessary; the appropriate gauge depends on the client's condition and prescribed therapy. Obtaining a surge protector (option
A) is irrelevant to the safe administration of IV therapy.
Extract:
A nurse is caring for a client who has an implanted venous access port.
Question 5 of 5
Which of the following should the nurse use to assess the port?
Correct Answer: C
Rationale: The correct answer is C: A noncoring needle.
To assess a port, a noncoring needle should be used because it is specifically designed for accessing ports without damaging the septum. Using an Angio catheter (
A) may be too large and cause damage, a butterfly needle (
B) is not suitable for accessing ports, and a 25-gauge needle (
D) may be too small or not specifically designed for port access. Noncoring needles are the standard choice for accessing ports due to their design that minimizes trauma and ensures proper function.