ATI RN
ATI Comprehensive 2023 With NGN 180 Questions And Answers Questions
Extract:
A nurse is providing an in service about client evacuation during the fracture.
Question 1 of 5
Which of the following clients should the nurse instruct the staff to evacuate first?
Correct Answer: C
Rationale: The nurse should instruct the staff to evacuate the client who is ambulatory and receiving oxygen first. This client has a higher risk for respiratory compromise in an emergency situation due to their dependence on oxygen. Evacuating this client first ensures their safety and prevents potential complications. The other choices are less urgent:
A) The client who uses a wheelchair and is confused may need assistance but is not at immediate risk of respiratory distress.
B) The bedridden client wearing a hearing aid may require help but is not in immediate danger.
D) The client with a fracture in balance suspension traction is stable and can wait, prioritizing the client on oxygen.
Extract:
Nurses' Notes
Day 1, 0915:
The client's adult child reports the client has not slept for 2 days and has become obsessed with
cleaning the house and hosting parties. At times the client is overly joyous and has a very
elevated sense of self-confidence. The adult child states that the client has also demonstrated
very impulsive spending habits and expresses concern about the client giving away large sums
of money to others.
The client's speech is very pressured, disorganized, and loud. Client unable to recall the last time
they ate.
Day 1, 0930:
Client questioned about their hallucinations and states that the same person has been following
them around inside and outside the house for days. Client asks the person what they want but
never receives an answer, Client states that this person has never told them to do anything: they
just stare and smile.
Question 2 of 5
For each assessment finding, click to specify if the finding is consistent with psychosis or mania.
Correct Answer: A,B,C,D,E
Rationale: Both psychosis and mania can present with hallucinations, lack of sleep, excessive spending, disorganized thoughts, and pressured speech. These symptoms overlap but are characteristic of both conditions.
Extract:
Question 3 of 5
A nurse is performing a neurological examination on a client as part of a complete physical assessment. The nurse should identify that cranial nerve XI(11) is intact when the client performs which of the following actions?
Correct Answer: A
Rationale: The correct answer is A: Shrugs his shoulders. Cranial nerve XI, also known as the accessory nerve, controls the movement of the sternocleidomastoid and trapezius muscles. When the client shrugs his shoulders, the nurse is assessing the function of these muscles, which are innervated by cranial nerve XI. This action indicates the integrity of the nerve.
Other choices are incorrect because:
B: Smiling symmetrically is controlled by cranial nerve VII (facial nerve).
C: Closing eyes tightly is controlled by cranial nerve VII (facial nerve).
D: Identifying a familiar scent is controlled by cranial nerve I (olfactory nerve).
Extract:
A nurse and assistive personnel are assigned a group of clients on the unit.
Question 4 of 5
Which of the following clients should the nurse instruct the AP to report to the nurse?
Correct Answer: D
Rationale: The correct answer is D. A blood pressure of 88/52 mmHg is considered hypotensive and requires immediate attention. The nurse should instruct the AP to report this client to the nurse promptly for further assessment and intervention to prevent potential complications such as shock.
Choice A is incorrect because not receiving compression stockings, while important, does not pose an immediate threat to the client's health.
Choice B is incorrect as assisting a client to the restroom is within the scope of the AP's duties and does not require immediate attention from the nurse.
Choice C is incorrect as eating only 50% of a meal does not indicate an urgent issue that needs to be reported to the nurse.
Extract:
A nurse in an antepartum unit is caring for a client.
Nurses' Notes
2000:
Client is 38-year-oid, 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 was diagnosed with gestational diabetes at 28 weeks of gestation.
Question 5 of 5
For each potential assessment finding, click to specify if the finding is consistent with chorioamnionitis or preeclampsia. Each finding may support more than one disease process. Note: Each column must have at least 1 response option selected.
| Findings | Chorioamnionitis | Preeclampsia |
|---|---|---|
| Elevated uric acid level | ||
| Blurred vision | ||
| Decreased platelet count | ||
| Purulent amniotic fluid | ||
| Fever |
Correct Answer: B,C,D,E
Rationale: Findings like fever, purulent amniotic fluid, decreased platelets, and elevated uric acid support chorioamnionitis. Blurred vision is more indicative of preeclampsia.