Review ATI PN Fundamentals 2023

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ATI PN Fundamentals 2023

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Total Questions : 51

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Question 1:

Day 1, 1030:

Amoxicillin 500 mg PO every 8 hr Metoprolol 50 mg PO daily
Urine culture and sensitivity

Day 3, 1700:

Metronidazole 250 mg PO three times daily
Obtain stool culture and sensitivity to test for Clostridium difficile.

Day 1, 1115:
Client presents with 3-day history of fever and chills. Reports urinary frequency and urgency, nausea, and flank pain. Client declines oral fluids. Tenderness noted upon palpation of the bladder.
Day 3, 1600:
Client reports increasing abdominal cramping and pain. Unable to tolerate oral fluids, vomited x2. Has had three loose stools since 1000 this morning. Vital signs obtained and provider notified.

Hypertension
Allergic to penicillin

A nurse is assisting in the care of a client who has a urinary tract infection.

Exhibits

The nurse is reviewing the client's medical record. Which of the following actions should the nurse take? Select all that apply.

A. Recommend increasing the dose of metoprolol B. Clarify the prescription for amoxicillin with the provider. C. Ensure the client wears a surgical mask when they are outside their room. D. Request a prescription for an antiemetic medication E. Place the client on contact precautions.

Answer and Explanation

Choice A:

The client is already on a daily dose of Metoprolol, and there is no indication that the dose should be increased. In fact, it is important to monitor the client's blood pressure and heart rate closely due to the potential side effects of Metoprolol.

Choice B:

This is the appropriate action since the client is allergic to penicillin, and the prescription for amoxicillin should be reviewed with the provider.

Choice C:

There is no indication from the information provided that the client requires a surgical mask when outside their room.

Choice D:

The client has been vomiting and experiencing abdominal cramping, which suggests nausea and discomfort. Requesting a prescription for an antiemetic medication is an appropriate action to address these symptoms.

Choice E:

There is no indication from the information provided that the client requires contact precautions. The client has a urinary tract infection and is not exhibiting symptoms consistent with a condition that requires contact precautions.

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Question 2:

A nurse is providing end-of-life care to a client who is experiencing dyspnea. Which of the following actions should the nurse take?

A. Provide oral care to the client once every 8 hr. B. Reposition the client once every 4 hr. C. Place the head of the client's bed flat. D. Use a fan to circulate air in the client's room.

Answer and Explanation

Choice A:

Providing oral care to the client once every 8 hr may not be sufficient to maintain oral hygiene. Frequent oral care is important for comfort and to prevent complications such as dry mouth, which can contribute to dyspnea.

Choice B:

Repositioning the client once every 4 hr can help improve comfort and reduce the risk of developing pressure ulcers. It can also help relieve pressure on the client's chest and lungs, which may help alleviate dyspnea.

Choice C:

Placing the head of the client's bed flat may not be appropriate, as this position can exacerbate dyspnea by causing the client's tongue to fall back and block the airway. Elevating the head of the bed or positioning the client in a semi-Fowler's or high Fowler's position may be more beneficial for managing dyspnea.

Choice D:

Using a fan to circulate air in the client's room may not be beneficial and could potentially worsen dyspnea by causing air to blow directly on the client's face or chest. It is important to maintain a comfortable room temperature and provide a quiet, peaceful environment for the client.

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Question 3:

A nurse is caring for an adult client who has acute lymphocytic leukemia. The client is refusing blood products. Which of the following responses should the nurse make?

A. "Not receiving blood will slow down your recovery." B. "I understand that you decided not to receive blood products." C. "You need to talk with your doctor about this." D. "Why are you refusing to receive blood products?"

Answer and Explanation

Choice A:

This response is judgmental and may cause the client to feel guilty or defensive.

Choice B:

This response shows empathy and respect for the client's decision.

Choice C:

This response may be appropriate if the client needs further information or counseling but should not be the initial response.

Choice D:

This response is confrontational and may cause the client to become defensive.

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Question 4:

A nurse is collecting data from an older adult client who lives alone. Which of the following findings should the nurse identify as the priority?

A. The client verbalizes regret about never marrying. B. The client has poorly fitting dentures. C. The client has no living family. D. The client is sedentary throughout most of the day.

Answer and Explanation

Choice A:

While the client's feelings about never marrying are important, they do not represent an immediate health risk or safety concern.

Choice B:

Poorly fitting dentures can affect the client's quality of life and ability to eat, but they do not represent an immediate health risk or safety concern.

Choice C:

While having no living family can be a social concern, it does not represent an immediate health risk or safety concern.

Choice D:

The client being sedentary throughout most of the day is a risk factor for numerous health problems, including cardiovascular disease, obesity, and decreased mobility. It is also a modifiable risk factor that can be addressed to improve the client's health and quality of life. Encouraging the client to engage in regular physical activity is a priority.

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Question 5:

A nurse is planning to obtain a client's oxygen saturation. Which of the following might influence the result of this test?

A. The client has a fever. B. The client has an elevated hemoglobin level. C. The client is wearing a ring. D. The client is wearing nail polish.

Answer and Explanation

Choice A:

A fever may influence the result of an oxygen saturation test but is not a direct factor.

Choice B:

An elevated hemoglobin level is unlikely to influence the result of an oxygen saturation test.

Choice C:

Wearing a ring is unlikely to influence the result of an oxygen saturation test.

Choice D:

Wearing nail polish can interfere with the accuracy of pulse oximetry readings by causing an inaccurate reflection of light, leading to a falsely low oxygen saturation reading.

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Question 6:

A nurse is caring for an adult client who has a developmental disability. The client requires an emergency appendectomy, and the staff cannot reach the appointed guardian. Which of the following is an appropriate action for the nurse to take?

A. Postpone the procedure until the staff contacts the guardian. B. Obtain consent from the client. C. Prepare the client for surgery with implied consent. D. Request that the provider sign the consent form.

Answer and Explanation

Choice A:

Postponing the procedure could put the client at risk if the appendicitis worsens.

Choice B:

Obtaining consent from the client may not be possible due to the client's developmental disability.

Choice C:

Preparing the client for surgery with implied consent is appropriate when the client is unable to provide consent and the procedure is urgent.

Choice D:

Requesting that the provider sign the consent form is not appropriate because the provider cannot provide consent on behalf of the client.

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Question 7:

A nurse is collecting data from a client who is 2 days postoperative following the placement of a colostomy. Which of the following findings should the nurse report to the provider?

A. The stoma protrudes slightly from the abdomen. B. The stoma appears dark in color. C. The stoma bleeds lightly when touched. D. The stoma is draining a small amount of liquid stool.

Answer and Explanation

Choice A:

A stoma that protrudes slightly from the abdomen is normal after colostomy surgery.

Choice B:

A stoma that appears dark in color may indicate compromised blood flow and should be reported to the provider.

Choice C:

A stoma that bleeds lightly when touched is normal after colostomy surgery.

Choice D:

A stoma that is draining a small amount of liquid stool is normal after colostomy surgery.

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Question 8:

A nurse is preparing to obtain a capillary blood specimen from a client. Which of the following actions should the nurse take? (Select all that apply)

A. Squeeze the client's finger until a blood drop forms B. Prick the side of the client's finger. C. Elevate the client's hand above the level of the heart D. Cleanse the client's finger with an iodine swab E. Using clean gloves

Answer and Explanation

Choice A:

Squeezing the client's finger until a blood drop forms can cause hemolysis and should be avoided.

Choice B:

Pricking the side of the client's finger is the correct technique for obtaining a capillary blood specimen.

Choice C:

Elevating the client's hand above the level of the heart can help increase blood flow to the finger.

Choice D:

Cleansing the client's finger with an iodine swab is necessary to prevent contamination of the blood specimen.

Choice E:

Applying clean gloves is necessary to maintain aseptic technique during the procedure.

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Question 9:

A nurse is collecting data from a client who is immobile and has a potential deep-vein thrombosis. Which of the following findings should the nurse report to the provider?

A. Tortuous veins B. Clammy skin C. Bradycardia D. Calf swelling

Answer and Explanation

Choice A:

Tortuous veins are a common finding in clients with deep-vein thrombosis and may not require immediate reporting.

Choice B:

Clammy skin may be a sign of poor circulation but is not specific to deep-vein thrombosis and may not require immediate reporting.

Choice C:

Bradycardia is not typically associated with deep-vein thrombosis and may not require immediate reporting.

Choice D:

Calf swelling is a common sign of deep-vein thrombosis and should be reported to the provider immediately.

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Question 10:

A nurse is caring for a client who has a new prescription for a belt restraint. Which of the following actions should the nurse take?

A. Make sure four fingers fit between the restraint and the client's body. B. Apply the belt restraint over the client's gown. C. Check the client's skin integrity every 4 hr. D. Tie the belt restraint to the side rail of the bed.

Answer and Explanation

Choice A:

Ensuring that four fingers fit between the restraint and the client's body is large. The gap should fit only 2 fingers

Choice B:

his is the correct action because applying the belt restraint over the client's clothing or gown prevents direct skin contact, which can reduce the risk of skin irritation, pressure ulcers, and allows for better assessment of skin integrity and comfort.

Choice C:

Checking the client's skin integrity every 4 hours is important, but it is not specific to the use of a belt restraint.

Choice D:

Tying the belt restraint to the side rail of the bed is not appropriate because it can restrict movement and cause injury.

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Total Questions : 51

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ATI PN Fundamentals 2023

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