ATI Custom NUR198 Exam 1 Summer BSN
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Free ATI Custom NUR198 Exam 1 Summer BSN Questions
1. A nurse is assessing an older adult client who received an opioid narcotic for incisional pain. Which of the following findings is the priority?
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Heart rate of 110/min.
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Blood pressure of 88/60 mm Hg
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Pain rating of 7 on a scale of 0 to 10
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Respiratory rate of 10/min
Explanation
Explanation
Opioid narcotics carry the critical risk of respiratory depression. A respiratory rate of 10/min is below the normal range of 12-20/min and signals early opioid-induced respiratory depression, which can rapidly progress to respiratory arrest. This is the most life-threatening finding and demands immediate intervention.
Why the other options are incorrect:
A. Heart rate of 110/min. Mild tachycardia can occur postoperatively due to pain or anxiety and is not immediately life-threatening compared to respiratory depression.
B. Blood pressure of 88/60 mm Hg. While hypotension requires attention, respiratory depression from opioids poses a more immediate and direct threat to survival in this context.
C. Pain rating of 7 on a scale of 0 to 10. Pain management is important but is not a priority over a compromised airway and respiratory status.
Opioid narcotics carry the critical risk of respiratory depression. A respiratory rate of 10/min is below the normal range of 12-20/min and signals early opioid-induced respiratory depression, which can rapidly progress to respiratory arrest. This is the most life-threatening finding and demands immediate intervention.
Why the other options are incorrect:
A. Heart rate of 110/min. Mild tachycardia can occur postoperatively due to pain or anxiety and is not immediately life-threatening compared to respiratory depression.
B. Blood pressure of 88/60 mm Hg. While hypotension requires attention, respiratory depression from opioids poses a more immediate and direct threat to survival in this context.
C. Pain rating of 7 on a scale of 0 to 10. Pain management is important but is not a priority over a compromised airway and respiratory status.
2. A nurse is admitting a client with gastroenteritis who has been repeatedly vomiting. The client reports numbness and tingling in the hands and feet. The nurse should recognize the client is experiencing which of the following acid-base imbalances?
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Respiratory acidosis
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Respiratory alkalosis
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Metabolic alkalosis
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Metabolic acidosis
Explanation
Explanation
Correct Answer: (C) Metabolic alkalosis
Repeated vomiting causes loss of hydrochloric acid (HCl) from the stomach, leading to a decrease in hydrogen ions and a rise in bicarbonate, resulting in metabolic alkalosis. Numbness and tingling in the extremities are classic neurological manifestations of alkalosis due to decreased ionized calcium from increased protein binding in an alkalotic state.
Why the other options are incorrect:
A. Respiratory acidosis This results from CO2 retention due to hypoventilation and is not associated with vomiting.
B. Respiratory alkalosis This results from hyperventilation and excess CO2 loss, not from gastrointestinal acid loss through vomiting.
D. Metabolic acidosis This would result from excess acid production or bicarbonate loss such as in diarrhea, not from repeated vomiting which removes acid.
Correct Answer: (C) Metabolic alkalosis
Repeated vomiting causes loss of hydrochloric acid (HCl) from the stomach, leading to a decrease in hydrogen ions and a rise in bicarbonate, resulting in metabolic alkalosis. Numbness and tingling in the extremities are classic neurological manifestations of alkalosis due to decreased ionized calcium from increased protein binding in an alkalotic state.
Why the other options are incorrect:
A. Respiratory acidosis This results from CO2 retention due to hypoventilation and is not associated with vomiting.
B. Respiratory alkalosis This results from hyperventilation and excess CO2 loss, not from gastrointestinal acid loss through vomiting.
D. Metabolic acidosis This would result from excess acid production or bicarbonate loss such as in diarrhea, not from repeated vomiting which removes acid.
3. A nurse is assessing an older adult client with a history of chronic kidney disease (CKD). The client reports increased fatigue and swelling in the lower extremities. What is the nurse's priority action?
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Assess the client's blood pressure and weight.
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Encourage the client to elevate their edematous extremities.
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Teach the client about low-sodium diet options.
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Administer a potassium-sparing diuretic medication.
Explanation
Explanation
Correct Answer: (A) Assess the client's blood pressure and weight.
Following the nursing process, assessment always precedes intervention. In a CKD client presenting with fatigue and lower extremity edema, the priority is to assess blood pressure and weight to quantify fluid retention and determine the severity of fluid overload. These findings will guide all subsequent interventions and any necessary provider notification.
Why the other options are incorrect:
B. Encourage the client to elevate their edematous extremities. Elevation is a comfort and supportive intervention but does not address the underlying fluid imbalance or establish the clinical severity of the situation, and cannot precede assessment.
C. Teach the client about low-sodium diet options. Dietary education is an important long-term management strategy for CKD but is not the priority action when the client is presenting with new or worsening symptoms that require immediate clinical evaluation.
D. Administer a potassium-sparing diuretic medication. Administering medication is an intervention that requires a provider order and must be preceded by a thorough assessment. Additionally, potassium-sparing diuretics carry significant risk in CKD clients due to already impaired potassium excretion, making this option potentially unsafe without assessment data first.
Correct Answer: (A) Assess the client's blood pressure and weight.
Following the nursing process, assessment always precedes intervention. In a CKD client presenting with fatigue and lower extremity edema, the priority is to assess blood pressure and weight to quantify fluid retention and determine the severity of fluid overload. These findings will guide all subsequent interventions and any necessary provider notification.
Why the other options are incorrect:
B. Encourage the client to elevate their edematous extremities. Elevation is a comfort and supportive intervention but does not address the underlying fluid imbalance or establish the clinical severity of the situation, and cannot precede assessment.
C. Teach the client about low-sodium diet options. Dietary education is an important long-term management strategy for CKD but is not the priority action when the client is presenting with new or worsening symptoms that require immediate clinical evaluation.
D. Administer a potassium-sparing diuretic medication. Administering medication is an intervention that requires a provider order and must be preceded by a thorough assessment. Additionally, potassium-sparing diuretics carry significant risk in CKD clients due to already impaired potassium excretion, making this option potentially unsafe without assessment data first.
4. A nurse is conducting a community education program on basal cell carcinoma. Which statement should the nurse make?
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"Basal cell carcinoma is an aggressive malignant proliferation of the dermis."
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"Basal cell carcinoma is more invasive than squamous cell carcinoma."
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"Basal cell carcinoma begins as a small, waxy nodule with rolled, translucent, pearly borders."
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"Basal cell carcinoma metastasizes through blood or the lymphatic system."
Explanation
Explanation
Correct Answer: (C) "Basal cell carcinoma begins as a small, waxy nodule with rolled, translucent, pearly borders."
This is the classic and accurate clinical description of basal cell carcinoma. It typically presents as a pearly, translucent papule or nodule with rolled borders and visible telangiectasia, arising from the basal layer of the epidermis, most often in sun-exposed areas.
Why the other options are incorrect:
A. "Basal cell carcinoma is an aggressive malignant proliferation of the dermis." Basal cell carcinoma arises from the epidermis, not the dermis, and is actually the least aggressive of the skin cancers with slow, localized growth.
B. "Basal cell carcinoma is more invasive than squamous cell carcinoma." Squamous cell carcinoma is more invasive and has a higher metastatic potential than basal cell carcinoma.
D. "Basal cell carcinoma metastasizes through blood or the lymphatic system." Basal cell carcinoma rarely metastasizes; this characteristic is more associated with squamous cell carcinoma and melanoma.
Correct Answer: (C) "Basal cell carcinoma begins as a small, waxy nodule with rolled, translucent, pearly borders."
This is the classic and accurate clinical description of basal cell carcinoma. It typically presents as a pearly, translucent papule or nodule with rolled borders and visible telangiectasia, arising from the basal layer of the epidermis, most often in sun-exposed areas.
Why the other options are incorrect:
A. "Basal cell carcinoma is an aggressive malignant proliferation of the dermis." Basal cell carcinoma arises from the epidermis, not the dermis, and is actually the least aggressive of the skin cancers with slow, localized growth.
B. "Basal cell carcinoma is more invasive than squamous cell carcinoma." Squamous cell carcinoma is more invasive and has a higher metastatic potential than basal cell carcinoma.
D. "Basal cell carcinoma metastasizes through blood or the lymphatic system." Basal cell carcinoma rarely metastasizes; this characteristic is more associated with squamous cell carcinoma and melanoma.
5. A nurse is caring for a hospitalized older adult. Which of the following is the priority nursing intervention if the client begins to experience confusion or disorientation?
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Administer a prescribed antianxiety medication as needed.
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Encourage the client to rest quietly to reduce stimulation.
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Conduct a thorough mental status examination.
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Ensure the client's environment is safe and free from hazards.
Explanation
Explanation
Correct Answer: (D) Ensure the client's environment is safe and free from hazards.
When a hospitalized older adult becomes confused or disoriented, the immediate priority is patient safety. A confused client is at high risk for falls, injury, and self-harm. Securing the environment eliminates immediate physical dangers before any other assessment or intervention is pursued, reflecting the priority of safety above all else.
Why Other Options are Incorrect:
A. Administer a prescribed antianxiety medication as needed. Antianxiety medications can worsen confusion and increase fall risk in older adults; administering them is not the priority and may be contraindicated until the cause of confusion is identified.
B. Encourage the client to rest quietly to reduce stimulation. While reducing stimulation can be helpful, it does not address the immediate safety risks posed by an acutely confused and disoriented client.
C. Conduct a thorough mental status examination. A mental status examination is an important assessment step but cannot take priority over ensuring the client's immediate physical safety in the environment.
Correct Answer: (D) Ensure the client's environment is safe and free from hazards.
When a hospitalized older adult becomes confused or disoriented, the immediate priority is patient safety. A confused client is at high risk for falls, injury, and self-harm. Securing the environment eliminates immediate physical dangers before any other assessment or intervention is pursued, reflecting the priority of safety above all else.
Why Other Options are Incorrect:
A. Administer a prescribed antianxiety medication as needed. Antianxiety medications can worsen confusion and increase fall risk in older adults; administering them is not the priority and may be contraindicated until the cause of confusion is identified.
B. Encourage the client to rest quietly to reduce stimulation. While reducing stimulation can be helpful, it does not address the immediate safety risks posed by an acutely confused and disoriented client.
C. Conduct a thorough mental status examination. A mental status examination is an important assessment step but cannot take priority over ensuring the client's immediate physical safety in the environment.
6. A nurse is providing teaching to a client who has had a biopsy of a superficial skin lesion that indicates malignant melanoma. The nurse should include which of the following options as the treatment of choice?
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Radiation therapy
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Surgical excision
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Chemotherapy
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Cryosurgery
Explanation
Explanation
Correct Answer: (B) Surgical excision
Surgical excision is the primary and definitive treatment for malignant melanoma. Wide local excision with clear margins is the standard of care, as it physically removes the tumor and reduces the risk of local recurrence and metastatic spread.
Why the other options are incorrect:
A. Radiation therapy Radiation is not the primary treatment for melanoma as it is relatively radioresistant. It may be used as adjuvant therapy in specific advanced cases.
C. Chemotherapy Chemotherapy has a limited role in melanoma and is generally reserved for advanced or metastatic disease, not as the primary treatment.
D. Cryosurgery Cryosurgery is used for benign or pre-malignant skin lesions and is not appropriate as the treatment of choice for malignant melanoma.
Correct Answer: (B) Surgical excision
Surgical excision is the primary and definitive treatment for malignant melanoma. Wide local excision with clear margins is the standard of care, as it physically removes the tumor and reduces the risk of local recurrence and metastatic spread.
Why the other options are incorrect:
A. Radiation therapy Radiation is not the primary treatment for melanoma as it is relatively radioresistant. It may be used as adjuvant therapy in specific advanced cases.
C. Chemotherapy Chemotherapy has a limited role in melanoma and is generally reserved for advanced or metastatic disease, not as the primary treatment.
D. Cryosurgery Cryosurgery is used for benign or pre-malignant skin lesions and is not appropriate as the treatment of choice for malignant melanoma.
7. The perioperative nurse is providing care for a client who is recovering on the postsurgical unit 8 hours after surgery. The client is reluctant to ambulate, citing the need to recover in bed. Which of the following complications is the client currently at risk for developing?
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Fluid volume overload
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Pleural effusion
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Electrolyte imbalances
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Atelectasis
Explanation
Explanation
Correct Answer: (D) Atelectasis
Immobility after surgery causes shallow breathing, which allows alveoli to collapse and results in atelectasis. Without the expansion that movement and ambulation promote, secretions pool and lung segments collapse, making atelectasis the most immediate and direct complication of prolonged bed rest in the early postoperative period.
Why the other options are incorrect:
A. Fluid volume overload Fluid overload is related to excessive IV fluid administration or cardiac/renal dysfunction, not directly caused by immobility.
B. Pleural effusion Pleural effusion is an accumulation of fluid in the pleural space and is not a direct consequence of postoperative immobility in an otherwise uncomplicated surgical recovery.
C. Electrolyte imbalances While immobility can contribute to some metabolic changes over time, electrolyte imbalances in the immediate postoperative period are more directly linked to fluid management and drainage losses than to ambulation status.
Correct Answer: (D) Atelectasis
Immobility after surgery causes shallow breathing, which allows alveoli to collapse and results in atelectasis. Without the expansion that movement and ambulation promote, secretions pool and lung segments collapse, making atelectasis the most immediate and direct complication of prolonged bed rest in the early postoperative period.
Why the other options are incorrect:
A. Fluid volume overload Fluid overload is related to excessive IV fluid administration or cardiac/renal dysfunction, not directly caused by immobility.
B. Pleural effusion Pleural effusion is an accumulation of fluid in the pleural space and is not a direct consequence of postoperative immobility in an otherwise uncomplicated surgical recovery.
C. Electrolyte imbalances While immobility can contribute to some metabolic changes over time, electrolyte imbalances in the immediate postoperative period are more directly linked to fluid management and drainage losses than to ambulation status.
8. A nurse is caring for four clients who have drainage tubes. Which of the following clients should the nurse recognize as being at risk for hypokalemia?
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The client who has a nasogastric (NG) tube to suction
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The client who has an indwelling urinary catheter to gravity drainage
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The client who has a Jackson-Pratt drain inserted following surgery
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The client who has a chest tube to water-seal drainage
Explanation
Explanation
Gastric fluid is rich in potassium, hydrogen, and chloride. Continuous NG suction removes large volumes of gastric secretions, leading to significant potassium loss and placing the client at high risk for hypokalemia.
Why the other options are incorrect:
B. The client who has an indwelling urinary catheter to gravity drainage. A urinary catheter simply drains urine passively and does not cause abnormal electrolyte losses beyond normal urinary excretion.
C. The client who has a Jackson-Pratt drain inserted following surgery. A Jackson-Pratt drain removes wound drainage, which contains minimal potassium and does not cause significant electrolyte imbalances.
D. The client who has a chest tube to water-seal drainage. Chest tubes drain pleural fluid or air and do not contain significant potassium concentrations that would cause hypokalemia.
Gastric fluid is rich in potassium, hydrogen, and chloride. Continuous NG suction removes large volumes of gastric secretions, leading to significant potassium loss and placing the client at high risk for hypokalemia.
Why the other options are incorrect:
B. The client who has an indwelling urinary catheter to gravity drainage. A urinary catheter simply drains urine passively and does not cause abnormal electrolyte losses beyond normal urinary excretion.
C. The client who has a Jackson-Pratt drain inserted following surgery. A Jackson-Pratt drain removes wound drainage, which contains minimal potassium and does not cause significant electrolyte imbalances.
D. The client who has a chest tube to water-seal drainage. Chest tubes drain pleural fluid or air and do not contain significant potassium concentrations that would cause hypokalemia.
9. Prior to a surgical procedure, a nurse is teaching a client about post-operative interventions to prevent complications. The nurse is instructing the client on the use of deep breathing, coughing, and incentive spirometry when the client states "I don't know why you're focusing on my breathing. My surgery is on my hip, not my chest." What rationale for these instructions should the nurse provide?
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To prevent paralytic ileus
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To prevent pneumothorax
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To prevent pneumonia
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To prevent pulmonary embolus
Explanation
Explanation
Correct Answer: (C) To prevent pneumonia
Deep breathing, coughing, and incentive spirometry are standard postoperative pulmonary hygiene measures used to expand the lungs, clear secretions, and prevent atelectasis, which is the primary precursor to postoperative pneumonia. These interventions are necessary for all surgical clients regardless of the surgical site.
Why the other options are incorrect:
A. To prevent paralytic ileus Paralytic ileus is a gastrointestinal complication prevented through early ambulation and bowel stimulation, not pulmonary exercises.
B. To prevent pneumothorax Pneumothorax is not a typical postoperative complication for a hip surgery patient and is not the rationale for these exercises.
D. To prevent pulmonary embolus Pulmonary embolus prevention is achieved through anticoagulation therapy and early ambulation, not breathing exercises.
Correct Answer: (C) To prevent pneumonia
Deep breathing, coughing, and incentive spirometry are standard postoperative pulmonary hygiene measures used to expand the lungs, clear secretions, and prevent atelectasis, which is the primary precursor to postoperative pneumonia. These interventions are necessary for all surgical clients regardless of the surgical site.
Why the other options are incorrect:
A. To prevent paralytic ileus Paralytic ileus is a gastrointestinal complication prevented through early ambulation and bowel stimulation, not pulmonary exercises.
B. To prevent pneumothorax Pneumothorax is not a typical postoperative complication for a hip surgery patient and is not the rationale for these exercises.
D. To prevent pulmonary embolus Pulmonary embolus prevention is achieved through anticoagulation therapy and early ambulation, not breathing exercises.
10. A nurse is providing preoperative teaching for a client who is scheduled for a gastrectomy. Which of the following information regarding prevention of postoperative complications should the nurse include in the teaching?
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Instruct the client about the use of a sequential compression device.
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Discuss the need to remain in bed after surgery.
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Teach the client's family how to use the patient-controlled analgesia (PCA) pump.
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Review the pain scale with the client.
Explanation
Explanation
Correct Answer: (A) Instruct the client about the use of a sequential compression device.
Sequential compression devices (SCDs) are applied to the legs to promote venous return and prevent deep vein thrombosis (DVT), a common and potentially life-threatening postoperative complication. Teaching the client about SCDs preoperatively is directly relevant to postoperative complication prevention.
Why the other options are incorrect:
B. Discuss the need to remain in bed after surgery. Remaining in bed actually increases the risk of postoperative complications such as DVT, pneumonia, and ileus. Early ambulation is encouraged, making this instruction incorrect and potentially harmful.
C. Teach the client's family how to use the patient-controlled analgesia (PCA) pump. PCA pumps are designed to be operated only by the client. Teaching family members to operate it creates a serious risk of overmedication and is a safety violation.
D. Review the pain scale with the client. While pain assessment is important postoperatively, reviewing the pain scale is not specifically directed at preventing postoperative complications and is not the priority teaching point in this context.
Correct Answer: (A) Instruct the client about the use of a sequential compression device.
Sequential compression devices (SCDs) are applied to the legs to promote venous return and prevent deep vein thrombosis (DVT), a common and potentially life-threatening postoperative complication. Teaching the client about SCDs preoperatively is directly relevant to postoperative complication prevention.
Why the other options are incorrect:
B. Discuss the need to remain in bed after surgery. Remaining in bed actually increases the risk of postoperative complications such as DVT, pneumonia, and ileus. Early ambulation is encouraged, making this instruction incorrect and potentially harmful.
C. Teach the client's family how to use the patient-controlled analgesia (PCA) pump. PCA pumps are designed to be operated only by the client. Teaching family members to operate it creates a serious risk of overmedication and is a safety violation.
D. Review the pain scale with the client. While pain assessment is important postoperatively, reviewing the pain scale is not specifically directed at preventing postoperative complications and is not the priority teaching point in this context.
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