ATI RN
ATI RN Fundamentals Online Practice 2023 B Questions
Extract:
Question 1 of 5
Which of the following items should be recorded as 120 mL of fluid in the client's intake and output record?
Correct Answer: C
Rationale: 8 oz of ice chips is approximately equivalent to 120 mL because when ice melts, it reduces in volume by about half, so 8 oz of ice chips would melt to about 4 oz of water, which is approximately 120 mL.
Extract:
Nurses’ Notes
• The client reports a sudden onset of chest tightness and difficulty breathing starting approximately 30 minutes ago.
• The client is anxious and visibly distressed, clutching her chest intermittently.
• She has a history of hypertension and diabetes, which are being managed with medication.
• On examination, the client is sitting upright and appears to be in moderate respiratory distress.
• The client mentions feeling lightheaded and reports a slight headache.
• She is sweating profusely and her skin is pale.
• The client denies any recent physical exertion or known exposure to irritants.
Vital Signs
• Temperature: 37.2°C (99.0°F)
• Heart Rate: 104 beats per minute
• Respiratory Rate: 22 breaths per minute
• Blood Pressure: 158/92 mmHg
Physical Examination Results
• The client’s lungs exhibit bilateral wheezing and crackles upon auscultation.
• There is no visible swelling or edema in the extremities.
• The client has a dry cough that is intermittent.
• No cyanosis is noted around the lips or extremities.
• The client’s skin is cool and clammy.
• The client appears slightly disoriented when asked questions.
• There is no sign of trauma or injury.
Question 2 of 5
A 45-year-old female client is admitted to the emergency department with complaints of sudden shortness of breath and chest tightness. She has a history of hypertension and diabetes.Exhibits:A nurse is assessing the client at 0700 hrs. Which of the following actions should the nurse take first? A Initiate a cardiac enzyme panel
Correct Answer: D
Rationale: The client's symptoms of sudden shortness of breath, chest tightness, and anxiety, along with her history of hypertension and diabetes, are concerning for a possible cardiac event. An electrocardiogram (ECG) can provide immediate information about the heart's electrical activity and help identify if the client is experiencing a heart attack or other cardiac event. This should be the first action taken to quickly identify the cause of the client's symptoms and initiate appropriate treatment.
Extract:
A nurse is caring for a client who has a peripheral IV inserted for fluid replacement.
On Day 1, Lactated Ringer’s was infusing at 100 mL/hr into a 20-gauge IV catheter in the left hand. The IV dressing was dry and intact.
The IV site was without redness or swelling. The IV fluid was infusing well.
On Day 2, the IV site was edematous.
The skin surrounding the catheter site was taut, blanched, and cool to touch. The IV fluid was not infusing.
The nurse is assessing the client.
Question 3 of 5
Which of the following actions should the nurse take?
Correct Answer: A,B,C
Rationale:
Choice A: Stopping the IV infusion prevents further tissue damage from infiltration.
Choice B: Elevating the arm reduces swelling.
Choice C: Applying heat promotes comfort and reduces swelling.
Choice D: Starting a new IV is premature before managing the infiltration.
Extract:
A nurse responds to a call light and finds a patient lying on the bathroom floor.
Question 4 of 5
What should the nurse do first?
Correct Answer: A
Rationale: The first action the nurse should take when finding a patient on the floor is to check the patient for injuries. This is important to determine the extent of any potential harm.
Extract:
A nurse is caring for a client who had a spinal cord injury and has paraplegia. The client is alert and oriented.The client is repositioned every 2 hr. Passive range-of-motion exercises to lower extremities are performed once each day.On Day 5, the client’s feet are warm, pedal pulses are 2+ bilaterally, plantar flexion contractures are noted bilaterally, and the left heel has a 1.3 cm x 1.3 cm (0.5 in x 0.5 in) area of nonblanchable erythema, with skin intact.
Question 5 of 5
Which findings require intervention by the nurse?
Correct Answer: A,B,C
Rationale:
Choice A: Once-daily exercises are insufficient to prevent contractures.
Choice B: Nonblanchable erythema indicates a stage 1 pressure ulcer.
Choice C: Contractures require intervention to prevent disability.
Choice D: Normal pulses do not require intervention.