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Ace Your Test with ATI Anderson MS II. Actual Questions and Solutions - Full Set

Free ATI Anderson MS II. Questions

1. A nurse is assisting in the planning of care for a client who has acute glomerulonephritis. Which of the following interventions should the nurse recommend including in the plan of care?
  • Encourage increased fluid intake.

  • Encourage frequent ambulation.

  • Place the client on a low-sodium diet.

  • Obtain weekly weight.

Explanation

Explanation
Correct Answer: C) Place the client on a low-sodium diet.
Acute glomerulonephritis causes inflammation of the glomeruli, leading to fluid retention, hypertension, edema, and proteinuria. A low-sodium diet is a priority intervention because sodium restriction reduces fluid retention, decreases edema, and helps control hypertension — all key concerns in glomerulonephritis. Encouraging increased fluid intake is contraindicated as it would worsen fluid overload and hypertension. Frequent ambulation is not a priority in the acute phase when the patient is typically on bed rest. Weight should be obtained daily (not weekly) to accurately monitor fluid retention and response to treatment.
2. A nurse is reinforcing health screening education with a group of clients. The nurse should recognize that which of the following clients has the greatest risk for hypertension?
  • A female client who is 44-years-old

  • A client who is African American

  • A male client who is 53-years-old

  • A client who is of Asian ethnicity

Explanation

Explanation
Correct Answer: B) A client who is African American.
African Americans have a significantly higher prevalence, earlier onset, and greater severity of hypertension compared to other ethnic groups. Research consistently identifies African American ethnicity as one of the strongest risk factors for hypertension, often linked to genetic predisposition, higher rates of salt sensitivity, and socioeconomic factors. While age and male sex are also risk factors, African American ethnicity carries the greatest overall risk among the options presented.
3. A nurse is reviewing the anatomy of the heart chambers and valves with a patient diagnosed with valvular heart disease. Based on your knowledge of cardiac anatomy and function, which of the following pairings between heart chambers and their correct names are accurate? (Select all that apply.)
  • Right ventricle — pumps deoxygenated blood into the pulmonary artery through the pulmonic valve.

  • Left atrium — receives oxygenated blood from the pulmonary veins.

  • Right atrium — receives deoxygenated blood from the body via the superior and inferior vena cava.

  • Tricuspid valve — located between the right atrium and right ventricle.

  • Left ventricle — pumps oxygenated blood into the pulmonary artery.

  • Aorta — receives deoxygenated blood from the right ventricle.

Explanation

Explanation
Correct Answer: A, B, C, and D
The right ventricle pumps deoxygenated blood through the pulmonic valve into the pulmonary artery to the lungs — correct. The left atrium receives freshly oxygenated blood returning from the lungs via the four pulmonary veins — correct. The right atrium receives deoxygenated blood from the systemic circulation via the superior and inferior vena cava — correct. The tricuspid valve is the atrioventricular valve between the right atrium and right ventricle — correct. The left ventricle pumps oxygenated blood into the aorta (not the pulmonary artery) — this is incorrect, making option E false. The aorta carries oxygenated blood from the left ventricle (not deoxygenated blood from the right ventricle) — making option F false.
4. A nurse is reinforcing discharge teaching with a client following a cataract extraction. Which of the following should the nurse include in the teaching?
  • Seeing flashes of light is an expected finding following extraction.
  • Avoid bending at the waist.
  • Remove the eye shield at bedtime.
  • Limit the use of laxatives if constipated.

Explanation

Explanation
Correct Answer: B) Avoid bending at the waist.
After cataract extraction, bending at the waist increases intraocular pressure, which can disrupt the surgical site and lead to serious complications such as bleeding or wound dehiscence. Patients should be instructed to bend at the knees instead. Flashes of light are not expected and should be reported immediately as they may indicate retinal detachment. The eye shield should be worn at bedtime, not removed. Laxatives may actually be recommended to prevent straining, which also raises intraocular pressure.
5. A nurse is collecting data from a client who is having an acute asthma exacerbation. When auscultating the client's chest, the nurse should expect to hear which of the following sounds?
  • Fine rales.

  • Expiratory wheeze.

  • Rhonchi.

  • Pleural friction rub.

Explanation

Explanation
Correct Answer: B) Expiratory wheeze.
During an acute asthma exacerbation, bronchospasm and airway inflammation cause narrowing of the lower airways. As air is forced through these narrowed passages — particularly during expiration — a high-pitched musical wheeze is produced. Expiratory wheezing is the hallmark auscultatory finding in asthma. Fine rales (crackles) indicate fluid in the alveoli, as seen in pneumonia or heart failure. Rhonchi are low-pitched sounds caused by secretions in large airways, associated with bronchitis or COPD. A pleural friction rub indicates pleuritis or pleural inflammation, not asthma.
6. A pediatric patient with chronic liver disease is found to have prolonged bleeding times and low platelet counts during assessment. Which role of the liver should the nurse evaluate to explain these hematologic abnormalities?
  • The liver stores excess iron and releases it immediately to increase platelet production when needed.

  • The liver produces clotting factors essential for hemostasis, and its dysfunction can impair clot formation.

  • The liver produces erythropoietin, which stimulates white blood cell production in the bone marrow.

  • The liver filters aged red blood cells, preventing anemia caused by excess breakdown of healthy cells.

Explanation

Explanation
Correct Answer: B) The liver produces clotting factors essential for hemostasis, and its dysfunction can impair clot formation.
The liver is responsible for synthesizing most clotting factors, including fibrinogen and prothrombin. When the liver is diseased or dysfunctional, production of these clotting factors is reduced, leading to prolonged bleeding times and an increased risk of hemorrhage. Erythropoietin is produced by the kidneys, not the liver, and iron storage does not directly regulate platelet production.
7. A patient presents with swollen, tender lymph nodes near an infected wound. How should the nurse interpret the role of these lymph nodes in the immune response?
  • They primarily produce lymph fluid to transport nutrients and waste products away from the infection site.

  • They store excess fluid from the bloodstream to prevent swelling in the infected tissue.

  • They regulate blood pressure around the infected area by constricting blood vessels.

  • They are filtering lymph fluid, trapping pathogens, and activating immune cells to fight the infection.

Explanation

Explanation
Correct Answer: D) They are filtering lymph fluid, trapping pathogens, and activating immune cells to fight the infection.
Lymph nodes are key components of the immune system. They act as biological filters that trap pathogens, foreign particles, and cellular debris carried in lymph fluid from surrounding tissues. Once pathogens are trapped, lymphocytes (B and T cells) housed in the lymph nodes are activated to mount an immune response. The swelling and tenderness (lymphadenopathy) near an infected wound is a sign that the lymph nodes are actively working to contain and fight the infection. Lymph nodes do not produce lymph fluid, store excess bloodstream fluid, or regulate blood pressure — those are functions of other body systems.
8. A nurse is caring for four clients on the urology unit. Which of the following data gathered by the nurse leads them to suspect Polycystic Kidney Disease?
  • The client admitted to the hospital has clinical findings of severe flank pain, nausea, and vomiting.

  • The client admitted to the hospital has clinical findings of polyuria, nocturia, sudden colicky pain, and a palpable kidney mass.

  • The client admitted to the hospital has clinical findings of urinary urgency, weak urine stream, and dysuria.

  • The client admitted to the hospital has clinical findings of periorbital edema, dark frothy urine, and elevated blood pressure.

Explanation

Explanation
Correct Answer: B) The client admitted to the hospital has clinical findings of polyuria, nocturia, sudden colicky pain, and a palpable kidney mass.
Polycystic Kidney Disease (PKD) is a genetic disorder characterized by the growth of numerous cysts in the kidneys, causing them to enlarge. Classic manifestations include a palpable kidney mass, colicky flank pain from cyst rupture or obstruction, polyuria, and nocturia due to impaired concentrating ability. Periorbital edema and dark frothy urine suggest nephrotic syndrome, urinary urgency and dysuria suggest a UTI or prostate issue, and isolated flank pain with nausea suggests kidney stones.
9. A nurse is reinforcing teaching to a female client who has acute cystitis and is to start therapy with phenazopyridine (Pyridium). Which of the following information should the nurse give to the client?
  • "Take the medication on an empty stomach."

  • "Use birth control while taking this medication to prevent pregnancy."

  • "Finish the medication in order to resolve the infection."

  • "This medication will turn your urine bright orange/red."

Explanation

Explanation
Correct Answer: D) "This medication will turn your urine bright orange/red."
Phenazopyridine (Pyridium) is a urinary analgesic that relieves the pain, burning, and urgency associated with cystitis. A critical and expected side effect is that it turns the urine a bright orange or red color, which can alarm patients if they are not forewarned. Educating the patient about this expected color change prevents unnecessary anxiety and promotes medication adherence. Phenazopyridine should be taken with food to reduce gastric upset, not on an empty stomach. It has no interaction with contraceptives. Importantly, phenazopyridine is not an antibiotic and does not treat or resolve the infection — it only relieves symptoms. The antibiotic prescribed separately is what resolves the infection.
10. A nurse is reviewing the laboratory results for a male adult client who is at risk for peripheral arterial disease from atherosclerosis. The nurse should identify that which of the following results places the client at risk?
  • Blood glucose 92 mg/dL

  • Elevated Cholesterol

  • Normal Sinus Rhythm on the Cardiac Monitor

  • Hypotension

Explanation

Explanation
Correct Answer: B) Elevated Cholesterol.
Elevated cholesterol is a major modifiable risk factor for atherosclerosis, which is the buildup of fatty plaques in arterial walls that leads to peripheral arterial disease. High levels of LDL cholesterol contribute to plaque formation, narrowing the arteries and reducing blood flow to the extremities. A blood glucose of 92 mg/dL is normal, normal sinus rhythm is a healthy finding, and hypotension does not contribute to atherosclerotic plaque formation.

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