ATI Custom NUR198 Exam 1 Summer BSN
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Free ATI Custom NUR198 Exam 1 Summer BSN Questions
The nurse is taking a health history of a new client who reports pain in his left lower leg and foot when walking. This pain is relieved with rest and the nurse observes that the left lower leg is hairless. When planning this client's care, the nurse should address which health problem?
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Coronary artery disease
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Deep vein thrombosis
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Chronic venous insufficiency
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Peripheral arterial disease
Explanation
Correct Answer: (D) Peripheral arterial disease
This client's presentation of intermittent claudication, pain in the leg and foot that occurs with walking and is relieved with rest, along with hair loss on the affected extremity, is classic for peripheral arterial disease. These findings result from reduced arterial blood flow to the extremities, which impairs tissue perfusion during increased oxygen demand from activity.
Why the other options are incorrect:
A. Coronary artery disease — This condition affects the coronary arteries and would present with chest pain or cardiac symptoms, not leg pain with ambulation and hair loss.
B. Deep vein thrombosis — This condition typically presents with unilateral leg swelling, warmth, and tenderness, not pain that is relieved with rest or hair loss.
C. Chronic venous insufficiency — This condition is associated with leg edema, skin changes, and aching that worsens with standing and improves with elevation, rather than pain specifically triggered by walking and relieved with rest.
A nurse is teaching a client who has hepatitis A. Which of the following information should the nurse include?
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Manifestations of the virus are similar to flu-like symptoms.
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Hepatitis A infects the kidneys.
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This viral infection will become chronic.
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A family history of hepatitis A increases your risk of acquiring the illness.
Explanation
Correct Answer: (A) Manifestations of the virus are similar to flu-like symptoms.
Hepatitis A commonly presents with flu-like symptoms, including fatigue, nausea, low-grade fever, and malaise, often before more specific liver-related symptoms such as jaundice develop. This is important client education, as the initial presentation can be mistaken for a common viral illness.
Why the other options are incorrect:
B. Hepatitis A infects the kidneys. Hepatitis A is a viral infection that specifically affects the liver, not the kidneys.
C. This viral infection will become chronic. Unlike hepatitis B and C, hepatitis A does not become a chronic infection; it is typically a self-limiting illness with full recovery.
D. A family history of hepatitis A increases your risk of acquiring the illness. Hepatitis A is transmitted through the fecal-oral route (contaminated food or water), not through genetic or family history; risk is related to exposure, not heredity.
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Obtain a 12-lead electrocardiogram (ECG).
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Initiate immediate defibrillation.
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Administer a dose of epinephrine intravenously.
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Perform a cardiopulmonary assessment.
Explanation
Ventricular fibrillation in a pulseless client is a life-threatening emergency requiring immediate defibrillation to terminate the chaotic electrical activity and restore an organized cardiac rhythm capable of producing a pulse. Early defibrillation is the single most important factor in improving survival for this rhythm.
Why the other options are incorrect:
A. Obtain a 12-lead electrocardiogram (ECG) — This would delay life-saving treatment; the rhythm is already identified as ventricular fibrillation, so immediate defibrillation takes priority over further diagnostic testing.
C. Administer a dose of epinephrine intravenously — While epinephrine may be given during resuscitation, it is not the priority action and should not delay immediate defibrillation.
D. Perform a cardiopulmonary assessment — Assessment findings have already established that the client is pulseless with ventricular fibrillation; further assessment would delay the critical, time-sensitive intervention of defibrillation.
A client presents reporting nausea, vomiting, and severe abdominal pain. The nurse notes bruising to the client's flanks bilaterally and a bluish-gray periumbilical discoloration. The client has a history of alcohol misuse and the client's wife states that he was on a drinking binge for the past 2 days. The nurse should anticipate receiving healthcare provider orders to treat which of the following health problems?
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Acute cholecystitis
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Acute hemorrhagic pancreatitis
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Acute liver failure
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Acute glomerulonephritis
Explanation
Correct Answer: (B) Acute hemorrhagic pancreatitis
This client's presentation is classic for acute hemorrhagic pancreatitis, particularly given the history of an alcohol binge, a well-known precipitating factor. The bruising to the flanks bilaterally (Grey Turner's sign) and the bluish-gray periumbilical discoloration (Cullen's sign) are both hallmark findings of retroperitoneal bleeding associated with hemorrhagic pancreatitis, resulting from the leakage of blood and pancreatic enzymes into the surrounding tissue.
Why the other options are incorrect:
A. Acute cholecystitis. This condition typically presents with right upper quadrant pain, often after eating fatty foods, and would not be associated with Grey Turner's or Cullen's sign.
C. Acute liver failure. While alcohol misuse can contribute to liver damage, this condition would more typically present with jaundice, ascites, and altered mental status rather than the specific flank and periumbilical bruising described.
D. Acute glomerulonephritis. This is a kidney-related condition typically presenting with hematuria, edema, and hypertension, not the abdominal pain and characteristic bruising patterns described in this scenario.
A client diagnosed with myocarditis reports fatigue and dyspnea with activity. Current findings include HR 108/min, decreased activity tolerance, and mild exertional shortness of breath. Which pathophysiologic change best explains these findings?
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Pericardial fluid accumulation
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Reduced myocardial contractility
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Increased systemic vascular resistance
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Valve leaflet calcification
Explanation
Correct Answer Is:
(B) Reduced myocardial contractility
Myocarditis causes inflammation of the heart muscle, which impairs the heart's ability to contract effectively. This reduced contractility leads to decreased cardiac output, resulting in compensatory tachycardia, fatigue, decreased activity tolerance, and exertional dyspnea as the body attempts to maintain adequate perfusion.
Why the other options are incorrect:
A. Pericardial fluid accumulation — This describes pericardial effusion, which is a separate condition involving fluid around the heart rather than inflammation of the heart muscle itself.
C. Increased systemic vascular resistance — This is more characteristic of conditions like hypertension and would not directly explain the fatigue and dyspnea pattern seen with myocarditis.
D. Valve leaflet calcification — This describes a structural valve disorder such as aortic stenosis, not the inflammatory myocardial process seen in myocarditis.
A nurse is preparing to administer clindamycin intravenously (IV) at a rate of 10 mg/min. The clindamycin is available as 900 mg in 100 mL normal saline (NS). How many mL/hr will the nurse plan to administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)
Explanation
First, determine the concentration of the solution: 900 mg ÷ 100 mL = 9 mg/mL. Next, calculate the rate in mL/min: 10 mg/min ÷ 9 mg/mL = 1.11 mL/min. Finally, convert to mL/hr: 1.11 mL/min × 60 min/hr = 66.7 mL/hr.
Correct Answer Is:
66.7 mL/hr
The perioperative nurse is obtaining a health history on a client who reports a family history of malignant hyperthermia. Which intervention is most appropriate to ensure this client's perioperative safety?
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Arrange for the treatment, dantrolene, to be available in the operating room.
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Administer a dose of intravenous (IV) diphenhydramine prior to surgery.
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Ensure the anesthesia team is alerted about the family history.
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Place the client on NPO status 24 hours prior to surgery.
Explanation
Malignant hyperthermia is a life-threatening hypermetabolic crisis triggered by certain anesthetic agents. Alerting the anesthesia team is the most critical intervention because they are responsible for selecting anesthetic agents and preparing appropriate countermeasures including dantrolene availability.
Why the other options are incorrect:
A. Arrange for the treatment, dantrolene, to be available in the operating room. While dantrolene must be available, this action is the responsibility of the anesthesia team once they are informed, not an independent nursing action to arrange first.
B. Administer a dose of intravenous (IV) diphenhydramine prior to surgery. Diphenhydramine is an antihistamine with no role in preventing or managing malignant hyperthermia.
D. Place the client on NPO status 24 hours prior to surgery. Standard NPO guidelines are typically 8 hours for solids and 2 hours for clear liquids; 24 hours is excessive and not indicated specifically for malignant hyperthermia risk.
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Administer subcutaneous insulin.
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Monitor stools for gray discoloration.
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Initiate nothing-by-mouth (NPO) status.
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Assist the client in repositioning.
Explanation
Correct Answer: (C) Initiate nothing-by-mouth (NPO) status. Placing the client on NPO status is a priority intervention in acute pancreatitis because it rests the pancreas by preventing stimulation of pancreatic enzyme secretion, which helps reduce inflammation and pain and allows the pancreas to begin healing.
Why the other options are incorrect:
A. Administer subcutaneous insulin. Insulin administration is only necessary if the client has hyperglycemia related to pancreatic dysfunction; it is not a universal priority intervention for all clients with acute pancreatitis.
B. Monitor stools for gray discoloration. This assessment is more relevant to biliary obstruction and is not the priority intervention for actively managing acute pancreatitis symptoms.
D. Assist the client in repositioning. While comfort measures are helpful, resting the pancreas through NPO status takes priority over repositioning for symptom management.
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Adopting a low-fat diet.
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Encouraging regular physical activity.
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Limiting caffeine consumption.
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Increasing fluid intake.
Explanation
Given the client's sedentary lifestyle, regular physical activity should be prioritized as it directly addresses one of his most significant modifiable risk factors. Exercise helps lower blood pressure by improving cardiovascular fitness, promoting weight management, and reducing overall cardiovascular risk, making it a high-impact intervention for this client's specific risk profile.
Why the other options are incorrect:
A. Adopting a low-fat diet — While a healthy diet is beneficial, the client's history specifically highlights a high-sodium diet as a concern, and a low-fat diet alone does not directly address his sedentary lifestyle or sodium intake, which are more relevant to his blood pressure.
C. Limiting caffeine consumption — Caffeine is not identified as a risk factor in this client's history, making this a lower priority compared to addressing his sedentary lifestyle.
D. Increasing fluid intake — Increasing fluid intake is not an appropriate intervention for hypertension and would not help manage his blood pressure; in fact, excessive fluid intake could worsen hypertension.
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A strip showing a regular, narrow QRS complex rhythm with a normal, evenly spaced pattern.
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A strip showing an irregularly irregular rhythm with varying QRS amplitude and no discernible P waves.
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A strip showing a regular, uniform sawtooth-shaped waveform pattern.
Explanation
Atrial fibrillation is characterized by chaotic, disorganized atrial electrical activity that results in an irregularly irregular ventricular rhythm. There are no distinct P waves because the atria are quivering rather than contracting in an organized fashion, and the fibrillatory baseline replaces normal P wave activity.
Why the other options are incorrect:
A. A strip showing a regular, narrow QRS complex rhythm with a normal, evenly spaced pattern — This represents a normal sinus rhythm or regular tachycardia, both of which have organized, evenly spaced complexes, unlike the irregularity seen in atrial fibrillation.
C. A strip showing a regular, uniform sawtooth-shaped waveform pattern — This classic "sawtooth" appearance is characteristic of atrial flutter, which, unlike atrial fibrillation, typically has a regular atrial rate and rhythm.
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