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Ati rn comprehensive predictor 2023
Total Questions : 175
Showing 20 questions, Sign in for more1 week ago:
Client reports that manifestations of hopelessness and disinterest are lessened, but present. Sleep disturbance continues. Provider increased paroxetine to 30 mg daily. Return to clinic in 1 week.
2 weeks ago:
Client with a history of generalized anxiety disorder and major depressive disorder. Client presents with increased hopelessness, disinterest, and a change in sleep and appetite over several months. Client is currently taking fluoxetine 20 mg daily for the past year. Fluoxetine discontinued and paroxetine 10 mg daily started. Return to clinic in 1 week.
Today
0800:
Client presents to the clinic with reports of restlessness, abdominal pain, disorientation, and fever for the past 12 hr. States, "I don't know what is wrong with me." Client denies recent illness. Denies fatigue and chills. Reports falling yesterday but didn't hit their head. Reports taking ibuprofen for muscle soreness. Client reports continued sleep disturbances, feelings of hopelessness, and a disinterest in activities.
A nurse is caring for a client at a clinic.
Complete the following sentence by using the lists of options.
The client is at risk for developing
Explanation
Rationale for Correct Choices:
- Serotonin syndrome: The client presents with restlessness, fever, abdominal pain, and disorientation all classic signs of serotonin syndrome. These symptoms developed after a recent dose increase of a serotonergic medication, indicating a likely adverse drug reaction.
- Adverse effects of paroxetine: Paroxetine, an SSRI, can cause serotonin syndrome, especially when recently increased or combined with other serotonergic agents. The timing of the dose escalation aligns with the emergence of the client’s acute symptoms.
Rationale for Incorrect Choices:
- Psychosis: While disorientation is present, there is no evidence of hallucinations, delusions, or loss of reality testing, which are essential features of psychosis.
- Mania: The client does not show signs of elevated mood, grandiosity, pressured speech, or risky behavior, which are typical of mania.
- Anxiety: Although anxiety is part of the client’s history, the sudden onset of fever and autonomic instability points more clearly to a toxic reaction rather than worsening anxiety.
- Fluoxetine discontinuation: Fluoxetine has a long half-life, and discontinuation typically causes delayed withdrawal symptoms like dizziness or mood swings not the acute systemic symptoms noted here.
A nurse is providing teaching at a community health fair about electrical fire prevention. Which of the following information should the nurse Include in the teaching?
A nurse is assessing a client who was placed in restraints for aggressive behavior. The client is now calm and cooperative. Which of the following actions should the nurse take?
A nurse is assessing a 3-month-old infant whose parents report starting cow's milk feedings 1 week ago. Which of the following actions should the nurse take?
A nurse is caring for a client who is experiencing a postpartum hemorrhage and has a history of hypertension. Which of the following medications is contraindicated for this client?
A nurse is performing an annual wellness exam on an 8-year-old child whose last exam was one year ago. Which of the following findings should the nurse report to the provider?
4 weeks ago:
21-year-old client reports increased stress and worry for the last 3 months. Client is worried about academic performance due to inability to focus on studies. School performance is suffering. Denies illicit drug use and drinks in moderation socially on the weekends.
Discussed lifestyle modifications to reduce stress. Instructed client to return in 1 month to reevaluate symptoms.
Today:
Client reports a slight improvement in stress but is now having loss of appetite and difficulty sleeping.
Instructed client to begin trazodone per provider's prescription.
4 weeks ago:
- Weight 54.4 kg (120 lb)
- Height 162.6 cm (64 in)
- BMI 20.6
Today:
- Weight 51.7 kg (114 lb)
- Height 162.6 cm (64 in)
- BMI 19.6
A nurse is caring for a client in the outpatient health clinic.
For each potential nursing intervention, click to specify if the intervention is indicated or not indicated.
Explanation
Rationale:
- Instruct client to avoid foods that have been fermented or aged: This dietary restriction applies to monoamine oxidase inhibitors (MAOIs), not trazodone, which is a serotonin antagonist and reuptake inhibitor (SARI).
- Encourage client to sleep until later in the morning: Oversleeping can disrupt circadian rhythms and worsen fatigue. A consistent, balanced sleep schedule is more therapeutic.
- Advise client to notify provider if pregnant: Trazodone is a category C medication and should only be used in pregnancy if the benefits outweigh the risks. The provider must be informed if the client is or may become pregnant.
- Encourage high-calorie finger foods: The client has experienced weight loss and decreased appetite. Nutrient-dense, easy-to-eat foods can support caloric intake without requiring full meals.
- Advise client to rise slowly from sitting position: Trazodone can cause orthostatic hypotension. Educating the client to change positions slowly helps prevent dizziness and potential falls.
- Encourage naps during the day when client is tired: Daytime napping can interfere with nighttime sleep and may reduce trazodone’s effectiveness in establishing a healthy sleep pattern.
- Encourage a regular sleep-wake schedule: Trazodone is often prescribed for sleep difficulties. A consistent routine supports sleep hygiene and enhances the medication’s effectiveness.
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.
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
Rationale:
- Temperature: The child’s temperature is 37.4°C (99.3°F), which is mildly elevated. Crohn’s disease typically causes intermittent fever during flare-ups. Appendicitis often presents with a higher fever in later stages. Intussusception can cause low-grade fever due to bowel inflammation, making it the most consistent with this finding.
- Vomiting: Vomiting is uncommon in Crohn’s disease unless there’s obstruction or severe disease. In appendicitis, vomiting usually follows the onset of pain and is related to peritoneal irritation. Intussusception often involves vomiting early due to intermittent bowel obstruction, making it consistent with this client’s symptoms.
- Pain rating: A FLACC score of 5 indicates moderate pain. Crohn’s pain tends to be chronic and crampy rather than episodic. Appendicitis pain worsens over time and becomes localized, typically in the right lower quadrant. Intussusception causes intermittent, severe abdominal pain with sudden relief, matching the child’s pain episodes and behavior.
- Abdominal findings: Crohn’s disease rarely produces a palpable abdominal mass or sudden distension. Appendicitis can cause right-sided tenderness and decreased bowel sounds but does not typically involve a mass. Intussusception often presents with a distended abdomen, hypoactive bowel sounds, and a sausage-shaped mass in the right upper quadrant, as described.
- Stool: Crohn’s disease can lead to bloody, mucus-filled stools due to ulceration in the intestinal lining. Appendicitis does not typically alter stool characteristics unless perforation occurs. Intussusception is well known for producing “currant jelly” stools, composed of blood and mucus, aligning with this child’s bowel movement description.
A nurse is assessing a group of clients at risk of developing a pressure injury. The nurse should identify that which of the following clients is at the greatest risk?
1 week ago:
Guardians report 2-day history of fever, congestion, and cough. Toddler fussy, moderate amount of clear, thick nasal drainage noted. Frequent loose, non-productive cough. Lungs sound clear. Respirations easy and unlabored.
Today:
Guardians report toddler continues with a fever and is now vomiting and difficult to rouse. Guardians report administering aspirin and acetaminophen alternately during the past week. Toddler lethargic and frequently vomiting small amounts of clear fluid. Respirations easy and unlabored, nonproductive cough noted. Mucus membranes slightly dry. Guardians report no void today.
1 week ago:
Treat with antipyretics. Encourage fluid intake. Return to office if manifestations worsen. Start prescription for oseltamivir for 5 days.
1 week ago:
- Heart rate 114/min
- Respiratory rate 30/min
- Temperature 38.8° C (101.8° F)
Today:
- Heart rate 120/min
- Respiratory rate 22/min
- Temperature 39° C (102.2° F)
1 week ago:
- Influenza A positive (negative)
- Influenza B negative (negative)
A nurse is caring for a toddler in the outpatient setting.
Complete the following sentence by using the lists of options.
The nurse recognizes the toddler has likely developed
Explanation
Rationale for Correct Choices:
- Reye's syndrome: The toddler's worsening condition including vomiting, lethargy, and altered consciousness after a viral illness (influenza A) is consistent with Reye’s syndrome, which affects the liver and brain. The progression from mild viral symptoms to neurologic decline without respiratory compromise further supports this diagnosis.
- Aspirin administration: Giving aspirin during a viral illness in children is a well-known precipitant of Reye’s syndrome. The caregivers' report of alternating aspirin with acetaminophen confirms the exposure necessary to trigger the condition in a susceptible child.
Rationale for Incorrect Choices:
- Gastroenteritis: While vomiting is a feature of gastroenteritis, the absence of diarrhea and the presence of neurologic changes like lethargy and poor responsiveness make this unlikely. Additionally, the clear vomiting and lack of fluid intake without prior GI focus suggest another etiology.
- Bronchitis: Bronchitis typically causes a productive cough with wheezing, chest discomfort, and possible fever. This toddler's lungs are clear with a nonproductive cough, and neurologic signs are not typical of bronchitis.
- Acetaminophen administration: Acetaminophen is safe and commonly used to treat fever in toddlers. It is not associated with hepatic encephalopathy or neurologic complications seen in this scenario.
- Oseltamivir administration: Though oseltamivir may cause gastrointestinal side effects like nausea or vomiting, it does not explain the altered mental status and lethargy. It is also unlikely to cause such a significant clinical deterioration on its own.
A nurse is caring for a client who has a closed wound drainage system. Which of the following interventions should the nurse include in the plan of care?
A nurse is performing an abdominal assessment as part of a client's comprehensive physical examination. Which of the following is the final step the nurse should perform?
A nurse is assessing a client who has end-stage kidney disease. Which of the following findings should the nurse expect? (Select all that apply.)
A nurse is caring for a client who is to undergo a bilateral prophylactic mastectomy. The client states that her family opposes her decision. Which of the following responses should the nurse make?
A nurse is caring for a client who has vision loss. Which of the following actions should the nurse take? (Select all that apply.)
A nurse is preparing to administer labetalol 40 mg IV to a client. Available is labetalol 5 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
Explanation
Calculation:
Desired dose = 40 mg.
Available concentration = 5 mg/mL.
- Calculate the volume to administer.
Volume (mL) = Desired dose (mg) / Available concentration (mg/mL)
= 40 mg / 5 mg/mL
= 8 mL.
0800:
Client is alert and oriented to person, place, and time. BMI 34
Auscultation reveals S3. Apical pulse 88/min and regular. Crackles auscultated bilaterally throughout lungs. Edema noted in lower extremities, +3 bilaterally. Peripheral pulses 1+ bilaterally and cool skin palpated in lower extremities.
0830:
Brain natriuretic peptide (BNP) 350 ng/L (less than 100 ng/L)
A nurse on a medical-surgical unit is caring for a client.
Explanation
Rationale for Correct Choices
- Heart failure: The client’s symptoms bilateral crackles, +3 lower extremity edema, cool limbs with weak pulses, an S3 heart sound, and elevated BNP are classic signs of decompensated heart failure with volume overload and poor perfusion.
- Educate the client about sodium restriction: Sodium contributes to fluid retention and increased cardiac workload. Dietary sodium restriction is crucial in preventing fluid overload, thus reducing exacerbations of heart failure symptoms such as edema and dyspnea.
- Obtain a prescription for a diuretic: Diuretics like furosemide relieve volume overload by promoting fluid excretion. They help decrease pulmonary congestion, improve oxygenation, and reduce peripheral edema in heart failure patients.
- Daily weight: Monitoring weight helps detect subtle changes in fluid balance. A sudden weight gain of 2–3 pounds in 24 hours may signal worsening heart failure and the need for diuretic adjustment.
- Blood pressure: Blood pressure monitoring provides insight into cardiac output and guides medication titration. Both hypertension and hypotension can worsen outcomes in clients with heart failure.
Rationale for Incorrect Choices
- Endocarditis: This condition presents with fever, new or changing murmurs, petechiae, or positive blood cultures. The absence of infection signs and the presence of systemic fluid overload point away from endocarditis.
- Aortic stenosis: Typical signs include exertional dyspnea, syncope, chest pain, and a harsh systolic murmur not crackles, edema, or elevated BNP. This client’s profile better matches heart failure.
- Mitral stenosis: This condition may cause pulmonary congestion but often presents with a diastolic murmur and atrial fibrillation, which are not described here.
- Administer antibiotics as prescribed: Without clinical or laboratory signs of infection (fever, leukocytosis, or positive cultures), antibiotics are not appropriate for heart failure.
- Prepare the client for cardioversion: Cardioversion is used for arrhythmias like atrial fibrillation with rapid ventricular response. The client has a normal apical pulse and no dysrhythmia signs.
- Educate the client about valve replacement: Valve surgery is not indicated unless diagnostic findings confirm severe valvular disease. No murmur or echo data is provided here.
- Skin lesions: These are associated with endocarditis, not heart failure. Findings like Janeway lesions or Osler nodes are not reported in this case.
- Blood cultures: Indicated when bacteremia or endocarditis is suspected. Heart failure without infection signs does not warrant blood cultures.
- Fever: The client is afebrile, making infection less likely. Fever is not a feature of uncomplicated heart failure and does not need monitoring here.
A nurse is providing care for a client who is scheduled for electroconvulsive therapy. Which of the following conditions should the nurse identify as an increased risk for complications?
A nurse on a medical-surgical unit is notified that a mass casualty event has occurred in the community. Which of the following actions should the nurse plan to take?
A nurse is flushing a client's intermittent infusion device. The client states, "Why do you have to do that if you are not giving me medicine?" Which of the following statements should the nurse make?
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