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Ati Rn comprehensive predictor 2023
Total Questions : 159
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Human chorionic gonadotropin (hCG) level 30,000 international units/L (greater than 25,000 international units/L)
Hemoglobin 12 g/dl (greater the 11 g/dL)
Hematocrit 35% (greater than 33%)
A nurse is caring for a client at the clinic.
Complete the following sentence by
The client is at risk for
Explanation
An hCG level of 30,000 IU/L is significantly elevated and may suggest a molar pregnancy, especially when values are higher than expected for gestational age. In a molar pregnancy (hydatidiform mole), trophoblastic tissue proliferates abnormally, producing excessive hCG. This level, in combination with normal hemoglobin and hematocrit, makes other causes like spontaneous or induced abortion less likely.
Key Takeaways:
- Extremely elevated hCG levels can indicate gestational trophoblastic disease (molar pregnancy).
- Molar pregnancy is a nonviable pregnancy characterized by abnormal trophoblast proliferation.
- Normal hemoglobin and hematocrit reduce the likelihood of current bleeding or miscarriage.
A charge nurse is teaching a newly licensed nurse about clients designating a health care proxy in situations that require a durable power of attorney for health care (DPAHC). Which of the following information should the charge nurse include?
A nurse is caring for a newborn who is experiencing neonatal abstinence syndrome. Which of the following actions should the nurse take?
A nurse is reviewing the medical record of a client who has a prescription for intermittent heat therapy for a foot injury. Which of the following findings should the nurse identify as a contraindication for heat therapy?
A nurse is receiving a telephone prescription from a provider for a client who requires additional medication for pain control. Which of the following entries should the nurse make in the medical record?
A nurse is obtaining a client's manual blood pressure and is having difficulty auscultating sounds. Which of the following actions should the nurse take?
A nurse enters a client's room and sees a small fire in the client's bathroom. Identify the sequence of steps the nurse should take. (Move the steps into the box, placing them in the order of performance. Use all the steps.)
Explanation
D. Transport the client to another area of the nursing unit. The first priority is rescue ensuring the client’s safety by removing them from the immediate area of danger, which is consistent with the "RACE" fire safety protocol (Rescue, Alarm, Contain, Extinguish).
A. Activate the facility's fire alarm system. Once the client is safe, the next step is to activate the fire alarm to notify other staff and initiate emergency protocols throughout the facility.
B. Close all nearby windows and doors. Containing the fire by closing doors and windows limits the spread of smoke and flames, buying time for response teams to arrive and control the situation.
C. Use the unit's fire extinguisher to attempt to put out the fire. If it is safe and the fire is small and manageable, the final step is to extinguish the fire using a fire extinguisher, following appropriate safety procedures.
1300:
Child is accompanied by their parent. Parent reports that their child is experiencing stomach pain and occasional vomiting. Parent states the child eats well, but sometimes has severe pain that causes them to "draw their knees to their chest and scream, but then returns to being themself. Parent noted blood and mucus in the child's bowel movement today.
1310:
Child is alert and responsive to verbal stimuli. Pain rated as 5 on the Facial expression, Leg movement, Activity, Cry, Consolability (FLACC) scale. Lung sounds clear anterior and posterior. Respirations even, nonlabored. Heart rate regular. Abdomen distended with hypoactive bowel sounds x 4 quadrants and tenderness with light palpation noted in right upper quadrant. Small, oblong, palpable mass noted in upper right quadrant.
1315:
Child vomited approximately 50 ml light-colored emesis.
1320:
- Temperature 37.4° C (99.3° F)
- Heart rate 110/min
- Respiratory rate 26/min
- Blood pressure 95/56 mm Hg
A nurse in an acute care facility is caring for a toddler.
For each assessment finding below, click to specify if the assessment finding is consistent with Crohn's disease, appendicitis, or intussusception. Each finding may support more than 1 disease process.
Explanation
- Pain rating: Severe, intermittent abdominal pain where the child draws their knees to the chest and then returns to normal behavior is a classic symptom of intussusception. Neither Crohn’s disease nor appendicitis typically presents with this pattern, appendicitis pain is usually constant and worsening, while Crohn’s pain is chronic and non-episodic.
- Vomiting: Vomiting in intussusception is common and often non-bilious in early stages, aligning with the child's light-colored emesis. Vomiting also occurs in appendicitis, especially in the early stages. However, it is not a prominent or early symptom of Crohn’s disease unless obstruction is present.
- Stool: The presence of blood and mucus in the stool ("currant jelly stool") is strongly associated with intussusception and may also occur in Crohn’s disease during flares due to colonic inflammation. Appendicitis does not typically cause bloody or mucoid stools, making this finding inconsistent with that diagnosis.
- Temperature: A temperature of 37.4°C is within normal limits, appendicitis however may present with low grade fever. The absence of fever at this time limits its diagnostic value in this case.
- Abdominal findings: A distended abdomen with hypoactive bowel sounds and a palpable sausage-shaped mass in the right upper quadrant is highly indicative of intussusception. These findings are not characteristic of appendicitis, which usually involves RLQ pain, or Crohn’s, which rarely presents with a discrete palpable mass.
A nurse is caring for a client who is obese. The client is crying and states, "Everyone is staring at me because of my weight." Which of the following responses should the nurse make?
A nurse is caring for a client who is postoperative following total hip arthroplasty. Which of the following actions should the nurse take to prevent dislocation of the prosthesis?
11. A nurse is caring for a client who has a tracheostomy and requires suctioning. Identify the sequence of steps the nurse should follow after applying sterile gloves. (Move the steps into the box, placing them in the selected order of performance. Use all the steps.)
Explanation
C. Lubricate the catheter with sterile saline. After donning sterile gloves, the nurse should lubricate the catheter to reduce friction and prevent trauma to the tracheal mucosa during insertion.
B. Insert the catheter until resistance is felt. The catheter should be gently inserted into the tracheostomy until resistance is met, indicating that it has reached the carina. Inserting beyond this point may cause injury.
A. Withdraw the catheter 1 to 2 cm (0.4 to 0.8 in). Pulling back slightly after resistance ensures the catheter is not pressing directly on sensitive structures and is positioned correctly for effective suctioning.
D. Rotate the catheter while suctioning. Suction should be applied while withdrawing the catheter in a rotating motion to evenly clear secretions and minimize damage to the tracheal lining.
0800:
Pediatric provider's office note:
Caregiver reports that for the past 2 days their toddler has had a fever as high as 38.6° C (101.5° F), has been irritable, and refuses to eat or drink. Caregiver reports the toddler's older sibling was sick 5 days ago with upper respiratory infection.
Toddler is awake, active, and crying. Mucous membranes are pink and slightly dry. Capillary refill is less than 2 seconds. Skin is warm and dry. Tonsils are swollen and erythematous. No signs of respiratory distress noted. Has moderate amount of clear mucoid nasal secretions.
Rapid Group A Beta-hemolytic Streptococci (GABHS) test done and was negative. Throat culture obtained and sent to lab. Missed appointment for 15-month vaccinations, otherwise immunizations are up to date.
Caregiver provided with instructions about care of toddler. If toddler does not improve in 24 hr caregiver instructed to call for appointment to be seen.
2200:
18-month-old toddler brought to emergency department by caregivers. Toddler was seen earlier today in provider's office. Caregiver feels the child's breathing is getting worse and doesn't want to wait until tomorrow to see provider.
Toddler is awake and crying. No tears are noted. Mucous membranes are slightly moist and pink. No drooling noted. Skin is warm and dry Capillary refill is 2 seconds. Mild wheezing is heard in all lobes Respirations are rapid with slight subcostal retractions Abdomen is soft non-distended and bowel sounds are present Oxygen at L/min is administered via n/c as prescribed by provider.
0800:
- Pediatric provider's office note:
- Temperature 38.4° C (101.1° F)
- Heart rate 143/min
- Respiratory rate 26/min
- Blood pressure 88/48 mm Hg
2200:
Emergency department provider's note:
- Temperature 38.8° C (101.8 °F)
- Heart rate 156/min
- Respiratory rate 44/min
- Blood pressure 88/46 mm Hg
- Oxygen saturation is 90% on room air
A nurse is caring for an 18-month-old toddler in the emergency department.
For each potential assessment finding, click to specify if the finding is consistent with Epiglottitis, Respiratory Syncytial virus, or Acute Streptococcal Pharyngitis. Each finding may support more than 1 disease process.
Explanation
- Fever: Fever is a nonspecific but common symptom found in all three conditions—epiglottitis, RSV, and streptococcal pharyngitis. However, it is more severe and abrupt in epiglottitis and low to moderate in RSV and strep throat. In this case, the toddler has had a persistent fever over 38°C, consistent with both RSV and strep.
- Exudate on pharynx: Pharyngeal exudate is a hallmark sign of acute streptococcal pharyngitis, resulting from the inflammatory response to GABHS. It is not typical in RSV or epiglottitis, where erythema and swelling may occur but without purulent exudate.
- Wheezing upon auscultation: Wheezing is a classic sign of RSV, a lower respiratory viral infection leading to bronchiolitis and airway obstruction. It is not a feature of epiglottitis or strep throat, which involve the upper airway and oropharynx, respectively.
- Drooling: Drooling is strongly associated with epiglottitis, due to inflammation and swelling of the epiglottis which makes it painful and difficult to swallow. It is not typical in RSV or strep pharyngitis unless there is severe oral involvement or dehydration.
- Hypoxia: Hypoxia may occur in both epiglottitis and RSV due to airway obstruction or inflammation compromising oxygenation. In epiglottitis, it results from upper airway narrowing; in RSV, from lower airway inflammation and mucus plugging. It is not common in uncomplicated streptococcal pharyngitis.
- Tachypnea: Tachypnea is a sign of respiratory distress and is often present in both epiglottitis and RSV, as the body attempts to compensate for impaired gas exchange. It is not a primary feature of strep pharyngitis unless accompanied by systemic infection or high fever.
A nurse is caring for a client who is postoperative immediately following a cardiac catheterization with a right femoral approach. Which of the following actions should the nurse take?
A nurse is interviewing the partner of a client who was admitted in the manic phase of bipolar disorder. The partner states, "I don't know what to do. Everything has been happening so quickly." Which of the following responses by the nurse is therapeutic?
0800:
Guardian states child was awake most of the night complaining of pain, currently asleep. Heart rate regular without murmur. Respirations easy, shallow, Breath sounds clear throughout. Abdomen soft, tender in incisional area upon palpation. Absent bowel sounds. Right lower quadrant abdominal dressing dry and intact.
1200:
Child rates abdominal pain as 6 on the FACES pain rating scale. Alert and irritable, cooperates with coaxing/playing Child refuses use of incentive spirometer. Heart rate regular without murmur. Respirations easy shallow. Breath sounds clear throughout Abdomen soft, more tender upon palpation as compared to 0800. Absent bowel sounds. Right lower quadrant abdominal dressing dry and intact.
0800:
- Temperature 37°C(98.6°F) temporal
- Heart rate 118/min
- Respiratory rate 20/min
- Blood pressure 927/52 mm Hg
- Weight 13.6 kg (30 lb)
1200:
- Temperature 37.2 (98.9°F) temporal
- Heart rate 126/min
- Respiratory rate 22min
1600:
- Temperature 37.7° C (99.9° F) temporal
- Heart rate 124/mini
- Respiratory rate 24/min
Acetaminophen 120 mg rectally every 4 hr as needed for temperature greater than or equal to 38.5° C (101.3° F)
Morphine sulfate 1 mg IV every 3 hr as needed for pain
1215:
Morphine sulfate 1 mg IV
A nurse on a pediatric unit is caring for a preschooler who is postoperative following an appendectomy.
Complete the following sentence by using the lists of options.
The child is at risk for developing
Explanation
- Postoperative ileus: Ileus is a common complication after abdominal surgery due to anesthesia, opioid use, and limited mobility. It presents as delayed return of bowel function, marked by absent bowel sounds and abdominal discomfort. In this case, the child has absent bowel sounds and increasing tenderness, supporting this risk.
- Atelectasis: Atelectasis generally presents with diminished breath sounds and hypoxia, not clear breath sounds. Although the child has shallow respirations and is refusing the incentive spirometer, there are no respiratory findings such as decreased oxygen saturation or adventitious breath sounds that support this condition currently.
- Peritonitis: Peritonitis would present with systemic symptoms like fever, severe abdominal pain, rebound tenderness, or signs of sepsis. The child has mild abdominal tenderness and stable vital signs, which do not indicate peritoneal inflammation at this time.
- Urinary retention: This would be characterized by lack of urination, bladder distension, or discomfort—none of which are noted in the scenario. The child’s urinary output and bladder status are not identified as concerns, making this diagnosis unlikely.
- Absent bowel sounds: This is a key clinical sign of ileus. After surgery, bowel activity should return gradually. Continued absence of sounds, especially along with abdominal tenderness, strongly indicates impaired gastrointestinal motility.
- Shallow respirations: While shallow breathing is often a contributing factor to respiratory complications, in the context of abdominal surgery, it also limits diaphragmatic movement, which can further suppress bowel activity and contribute to postoperative ileus.
- Clear breath sounds: This is a normal respiratory finding and does not support the presence of atelectasis or other pulmonary complications. It suggests that lung fields are adequately ventilated despite shallow breathing.
- Intact abdominal dressing: This is an expected postoperative finding and does not support a diagnosis of infection, wound complication, or ileus. It indicates proper surgical wound healing.
A nurse is preparing a client for transfer to a long-term rehabilitation facility following a below-the-knee amputation of the right leg. Which of the following actions should the nurse take to protect the client's confidentiality?
A nurse is discussing effective communication techniques for a client who has visual impairment with a newly licensed nurse. Which of the following statements by the nurse indicates an understanding of the teaching?
A home care nurse is making a follow-up visit with a client who has COPD and is using a compressed oxygen system in his home. Which of the following actions should the nurse take?
A nurse is teaching a client about self-administration of sublingual nitroglycerin. Which of the following statements should the nurse include?
A nurse is providing teaching to a client who has heart failure and a new prescription for furosemide. Which of the following statements should the nurse make?
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