ATI Custom NUR198 Exam 1 Summer BSN
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Free ATI Custom NUR198 Exam 1 Summer BSN Questions
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
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.
A nurse is providing teaching to a client who has nephrotic syndrome. The nurse should recognize that which of the following client statements indicates a need for further teaching?
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"I will notify my healthcare provider if I experience dysuria."
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"I should expect to be scheduled for a kidney biopsy."
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"I should increase my sodium intake."
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"I can expect to have swelling in my face."
Explanation
Clients with nephrotic syndrome experience significant fluid retention and edema due to protein loss and resulting fluid shifts; increasing sodium intake would worsen fluid retention and edema, so clients should instead be instructed to follow a sodium-restricted diet. This statement indicates a need for further teaching.
Why the other options are incorrect:
A. "I will notify my healthcare provider if I experience dysuria." This is an appropriate statement, as new urinary symptoms should be reported since clients with nephrotic syndrome are at increased risk for infection.
B. "I should expect to be scheduled for a kidney biopsy." This is accurate, as a kidney biopsy is often performed to determine the underlying cause of nephrotic syndrome and guide treatment.
D. "I can expect to have swelling in my face." This is a correct expectation, as periorbital and facial edema are classic findings in nephrotic syndrome due to fluid retention and low serum albumin.
A nurse is teaching a client with Raynaud's phenomenon about prescribed nifedipine. Which statement by the client indicates understanding?
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"This medication will increase my heart rate significantly."
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"I should avoid fluids while taking this medication."
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"This medication will help relax my blood vessels."
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"I will take this medication only when symptoms occur."
Explanation
Correct Answer: (C) This medication will help relax my blood vessels.
Nifedipine is a calcium channel blocker that causes vasodilation by relaxing smooth muscle in the blood vessel walls. For a client with Raynaud's phenomenon, this action helps prevent the vasospasm that leads to reduced blood flow to the extremities, decreasing the frequency and severity of episodes.
Why the other options are incorrect:
A. This medication will increase my heart rate significantly — Nifedipine primarily affects vascular smooth muscle and does not significantly increase heart rate; reflex tachycardia can occur but is not a significant expected effect and is not the therapeutic purpose of the medication.
B. I should avoid fluids while taking this medication — There is no need to restrict fluid intake while taking nifedipine.
D. I will take this medication only when symptoms occur — Nifedipine is typically taken on a scheduled basis to prevent vasospastic episodes, not only as needed when symptoms occur.
A nurse is caring for a client who just had an angiogram with contrast dye. Which of the following assessment findings would the nurse expect to be reduced if the client experiences an acute kidney injury?
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Serum potassium
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Urine output
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Heart rate
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Blood pressure
Explanation
Correct Answer: (B) Urine output. Contrast-induced acute kidney injury impairs the kidneys' ability to filter and excrete urine effectively, leading to decreased urine output, oliguria, as one of the earliest and most direct signs of reduced kidney function.
Why Other Options are Incorrect:
A. Serum potassium. Acute kidney injury typically causes an increase, not a decrease, in serum potassium, since the kidneys are less able to excrete potassium.
C. Heart rate. Heart rate is not a direct or reliably reduced finding associated with acute kidney injury; if anything, it may change in response to fluid or electrolyte imbalances rather than decrease predictably.
D. Blood pressure. Blood pressure often increases with acute kidney injury due to fluid retention and activation of the renin-angiotensin-aldosterone system, rather than decreasing.
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Explain the treatment options in detail to decrease fear.
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Respect the client's silence and offer to be available when they're ready to talk.
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Notify the healthcare provider of the client's behavior.
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Encourage the client and their family to join a cancer support group.
Explanation
Respecting the client's need for silence while remaining available shows empathy and allows the client time to process their new diagnosis at their own pace, without forcing communication before they are emotionally ready.
Why the other options are incorrect:
A. Explain the treatment options in detail to decrease fear — Providing detailed information when the client is withdrawn and not ready to engage may overwhelm the client further rather than decrease their fear or anxiety.
C. Notify the healthcare provider of the client's behavior — Withdrawal after receiving a new cancer diagnosis is a normal, expected emotional response and does not require immediate provider notification.
D. Encourage the client and their family to join a cancer support group — While support groups can be beneficial, suggesting this while the client is withdrawn and not ready to discuss the diagnosis is not the most immediately appropriate intervention; the client's current emotional needs should be addressed first.
A nurse is providing discharge instructions to a client who underwent surgical incision and drainage of an infected pilonidal cyst. Which of the following instructions should the nurse include to promote healing and prevent recurrence?
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"Clean the area daily with hydrogen peroxide."
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"Avoid sitting for more than 5 minutes at a time for the next 2 weeks."
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"Apply warm compresses to the area twice daily."
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"Keep the area clean, dry, and free from hair."
Explanation
Keeping the pilonidal area clean, dry, and free from hair helps prevent irritation, infection, and recurrence, as hair follicles in this area are often associated with the development of pilonidal cysts.
Why the other options are incorrect:
A. "Clean the area daily with hydrogen peroxide." — Hydrogen peroxide can be harsh and damaging to healing tissue; the area should typically be cleaned with mild soap and water instead.
B. "Avoid sitting for more than 5 minutes at a time for the next 2 weeks." — This instruction is overly restrictive and not a standard recommendation; while prolonged sitting should generally be minimized, a strict 5-minute limit is not an accurate or practical guideline.
C. "Apply warm compresses to the area twice daily." — While warm compresses may be used in some cases to promote comfort, this is not the primary teaching point for preventing recurrence; keeping the area clean, dry, and hair-free is the key preventive measure.
A nurse is assessing a client who has an obstruction of the common bile duct resulting from chronic cholecystitis. Which finding should the nurse expect?
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Clay-colored stools
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Ecchymosis of the extremities
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Tenderness in the left upper abdomen
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Straw-colored urine
Explanation
Correct Answer: (A) Clay-colored stools. When the common bile duct is obstructed, bile cannot flow into the intestines to give stool its normal brown color. Without bilirubin reaching the intestines, stools become pale or clay-colored, a classic and expected finding of biliary obstruction.
Why Other Options are Incorrect:
B. Ecchymosis of the extremities. While prolonged biliary obstruction can eventually impair vitamin K absorption and clotting, this is not the primary or most direct expected finding compared to the clear stool color change.
C. Tenderness in the left upper abdomen. Cholecystitis and biliary obstruction typically cause right upper quadrant tenderness, corresponding to the location of the gallbladder, not the left upper abdomen.
D. Straw-colored urine. With bile duct obstruction, urine actually becomes dark, tea-colored due to excess bilirubin being excreted through the kidneys, not straw-colored.
A nurse is developing a teaching plan for an adult client with asthma. The nurse determines the teaching has been successful when the client makes which of the following statements?
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"I will avoid physical activity to prevent asthma attacks."
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"I should expect to use my rescue inhaler daily."
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"I should use my cortisone inhaler followed by my albuterol inhaler."
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"I should closely monitor my symptoms using a peak expiratory flow (PEF) monitor."
Explanation
Correct Answer: (D) "I should closely monitor my symptoms using a peak expiratory flow (PEF) monitor."
Peak expiratory flow monitoring allows the client to objectively track lung function and identify early changes in airway obstruction before symptoms become severe, enabling proactive self-management and timely intervention. This statement reflects appropriate understanding of asthma self-monitoring, an essential component of effective long-term asthma management.
Why the other options are incorrect:
A. "I will avoid physical activity to prevent asthma attacks." This statement indicates a misunderstanding; clients with asthma are generally encouraged to engage in regular physical activity, with pre-treatment using a bronchodilator if needed, rather than avoiding exercise altogether. B. "I should expect to use my rescue inhaler daily." Frequent daily use of a rescue inhaler indicates poorly controlled asthma and would signal a need for reassessment of the treatment plan, not an expected or desirable outcome of successful teaching. C. "I should use my cortisone inhaler followed by my albuterol inhaler." This statement reflects incorrect technique; the bronchodilator (albuterol) should be used first to open the airways, followed by the corticosteroid inhaler to allow for better medication deposition in the lungs.
A nurse is caring for a client with pancreatitis who is at risk of acute respiratory distress syndrome (ARDS). Which assessment finding is the priority cue indicating the client may be developing ARDS?
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Blood pressure of 105/70 mm Hg
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Productive cough with sputum
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Temperature of 38.1°C (100.6°F)
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Bilateral crackles and dyspnea
Explanation
Correct Answer:
(D) Bilateral crackles and dyspnea
Bilateral crackles and dyspnea are hallmark early findings of ARDS, reflecting fluid accumulation in the alveoli and impaired gas exchange caused by increased capillary permeability in the lungs. In a client with pancreatitis, inflammatory mediators released during the disease process can damage the pulmonary capillary membrane, leading to noncardiogenic pulmonary edema. Bilateral crackles with dyspnea directly signal this progressive respiratory compromise and represent the priority assessment finding requiring immediate attention and intervention.
Why the other options are incorrect:
A. Blood pressure of 105/70 mm Hg This blood pressure reading is within a normal to slightly low-normal range and does not indicate a respiratory complication; it is not specific to ARDS development.
B. Productive cough with sputum A productive cough with sputum is more suggestive of a respiratory infection or bronchitis rather than ARDS, which typically presents with a dry cough, if any, in its early stages, along with worsening dyspnea.
C. Temperature of 38.1°C (100.6°F) A mild fever can be associated with the underlying pancreatitis or a general inflammatory response, but it is a nonspecific finding that does not directly indicate the respiratory compromise characteristic of ARDS.
The nurse educator is teaching nurses in the emergency department (ED) about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way?
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Invasive hemodynamic monitoring is required during treatment of hypertensive emergencies.
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Hypertensive emergencies are associated with evidence of end-organ damage.
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Hypertensive urgency is treated with rest and benzodiazepines to lower blood pressure.
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The blood pressure is always higher in a hypertensive emergency.
Explanation
Correct Answer: (B) Hypertensive emergencies are associated with evidence of end-organ damage.
The key distinguishing feature between hypertensive urgency and hypertensive emergency is the presence of acute end-organ damage, such as to the brain, heart, kidneys, or eyes. Hypertensive emergency requires immediate blood pressure reduction to prevent further organ damage, while hypertensive urgency involves severely elevated blood pressure without evidence of such damage.
Why the other options are incorrect:
A. Invasive hemodynamic monitoring is required during treatment of hypertensive emergencies — While this may occur in some cases, it is not the defining characteristic that differentiates urgency from emergency.
C. Hypertensive urgency is treated with rest and benzodiazepines to lower blood pressure — Hypertensive urgency is typically managed with oral antihypertensive medications, not benzodiazepines.
D. The blood pressure is always higher in a hypertensive emergency — Blood pressure readings can overlap between urgency and emergency; the presence of end-organ damage, not the specific blood pressure number, defines the emergency classification.
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