ATI RN
ATI Capstone Exam Questions
Extract:
Question 1 of 5
When considering the risk for heart failure, what would the nurse monitor the client diagnosed with infective endocarditis for on an ongoing basis?
Correct Answer: C
Rationale: The correct answer is C: Crackles, peripheral edema, and weight gain. In infective endocarditis, there is a risk of developing heart failure due to damage to the heart valves. Monitoring for crackles indicates fluid accumulation in the lungs, a sign of left-sided heart failure. Peripheral edema is a result of right-sided heart failure, which can occur in infective endocarditis. Weight gain is a common symptom of heart failure due to fluid retention. Flank pain with radiation to the groin and hematuria (choice
A) are more indicative of kidney issues rather than heart failure. Respiratory distress, chest pain, and use of accessory muscles (choice
B) are more suggestive of acute pulmonary conditions. Confusion, decreasing level of consciousness, and aphasia (choice
D) are symptoms of neurological issues, not heart failure.
Question 2 of 5
A nurse is assessing a client who has cirrhosis. Which of the following is an expected finding for this client?
Correct Answer: C
Rationale: The correct answer is C: Spider angiomas. In cirrhosis, the liver is damaged leading to increased pressure in the portal vein. This results in dilated blood vessels on the skin surface known as spider angiomas. This finding is expected due to the liver's inability to process blood effectively.
Choice A (Moist skin) is incorrect as cirrhosis commonly causes dry and itchy skin.
Choice B (Blood in the urine) is incorrect because cirrhosis typically does not directly affect the kidneys.
Choice D (Tarry stools) is incorrect as it is a symptom of gastrointestinal bleeding, which can occur in cirrhosis but is not a specific finding.
Question 3 of 5
A nurse in an emergency department is caring for a client who has deep partial- and full-thickness burns to his face, chest, abdomen, and upper arms. What is the nurse’s priority intervention for this client during the resuscitation phase of injury?
Correct Answer: B
Rationale: The correct answer is B: Maintain the airway. During the resuscitation phase of burn injuries, priority is given to ensuring airway patency to prevent respiratory distress and failure. Burns to the face, chest, and abdomen can lead to airway compromise due to swelling and damage. Maintaining the airway is crucial to ensure adequate oxygenation and ventilation. Pain management (choice
A) is important but not the priority in this phase. Inserting a urinary catheter (choice
C) is not a priority during the resuscitation phase. Initiating fluid resuscitation (choice
D) is important but only after ensuring airway patency.
Question 4 of 5
A client arrived via ambulance to the emergency department with a chief complaint of gastrointestinal bleeding for 2 hours. What will the triage nurse do first?
Correct Answer: C
Rationale: The correct answer is C: Obtain vital signs. The first step in triaging a patient with gastrointestinal bleeding is to assess their vital signs to determine the severity of the situation. Vital signs, such as blood pressure, heart rate, respiratory rate, and oxygen saturation, provide crucial information about the patient's condition and help prioritize the level of care needed. This immediate assessment allows the triage nurse to identify any signs of shock or instability, guiding further interventions and treatment. Inserting an NG tube (choice
A) or completing a head-to-toe assessment (choice
D) can wait until the patient's vital signs are stable and the immediate risk is addressed. Asking about precipitating events (choice
B) may provide important information but is not as urgent as assessing vital signs in this critical situation.
Question 5 of 5
A client is scheduled to have a percutaneous transluminal coronary angioplasty (PTCA) to treat coronary artery disease. What information about the balloon-tipped catheter would the nurse plan to include when providing client education concerning the procedure?
Correct Answer: C
Rationale:
Correct Answer: C - The catheter will be used to compress the plaque against the coronary blood vessel wall.
Rationale: During a PTCA procedure, a balloon-tipped catheter is used to compress the plaque against the vessel wall, widening the artery lumen and improving blood flow. This process does not involve cutting away the plaque or taking pressure measurements. Option A is incorrect as the catheter does not spring open but rather compresses the plaque. Option B is incorrect as the catheter is not used for pressure measurements. Option D is incorrect as there is no embedded blade to cut away the plaque.