ATI NUR275 Final Assessment SU1
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Free ATI NUR275 Final Assessment SU1 Questions
A nurse is teaching a class about vulnerable populations that are at risk for health disparities. The nurse should include that a client who lives in a crowded apartment building is at risk for which of the following conditions?
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Weight gain
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Rheumatoid arthritis
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Infectious diseases
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Deep vein thrombosis
Explanation
Correct Answer: (C) Infectious diseases
Living in crowded conditions is a well-established social determinant of health that significantly increases the risk of infectious diseases. Close proximity to others facilitates the transmission of airborne, droplet, and contact-spread pathogens including tuberculosis, influenza, COVID-19, and gastrointestinal infections. Overcrowded housing is a key factor contributing to health disparities in vulnerable populations.
Why Other Options are Incorrect:
A. Weight gain Weight gain is associated with factors such as sedentary lifestyle, poor dietary habits, and food insecurity, but it is not specifically linked to living in a crowded apartment building as a primary risk factor.
B. Rheumatoid arthritis Rheumatoid arthritis is an autoimmune condition influenced by genetic predisposition and immune system dysfunction. It is not caused by or significantly associated with crowded living conditions.
D. Deep vein thrombosis Deep vein thrombosis is associated with prolonged immobility, hypercoagulable states, and vascular injury. While poverty and lack of healthcare access may delay treatment, crowded living conditions alone are not a direct risk factor for DVT development.
A nurse is assessing an older adult client who is experiencing age-related changes. Which of the following findings should the nurse expect?
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Increased muscle mass
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Increased balance
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Increased joint stiffness
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Increased calcification of bones
Explanation
Correct Answer: (C) Increased joint stiffness
Increased joint stiffness is a normal and expected age-related change resulting from the deterioration of cartilage, decreased synovial fluid production, and reduced elasticity of connective tissues surrounding the joints. This leads to decreased range of motion and increased stiffness, particularly in the morning or after periods of inactivity.
Why the other options are incorrect:
Aging is associated with sarcopenia, which is the progressive loss of muscle mass and strength. Older adults experience decreased muscle mass rather than an increase, due to hormonal changes, decreased physical activity, and reduced protein synthesis.
Balance typically declines with age due to deterioration of vestibular function, proprioception, vision, and muscle strength. Older adults are at significantly increased risk for falls due to decreased balance, not improved balance.
While bone calcification sounds like it would increase bone density, aging is actually associated with decreased bone density and increased porosity, leading to osteoporosis. Older adults experience net bone resorption exceeding bone formation, resulting in weaker and more fracture-prone bones rather than increased calcification.
A nurse is preparing to provide care for a client in the emergency department who has syndrome of inappropriate antidiuretic hormone (SIADH). The client has a serum sodium of 115 mEq/L (136 to 145 mEq/L). Which of the following IV solutions should the nurse anticipate will be prescribed?
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Dextrose 5% in 0.45% sodium chloride
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3% sodium chloride
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0.9% sodium chloride
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Dextrose 5% in 0.9% sodium chloride
Explanation
SIADH causes excessive water retention leading to severe dilutional hyponatremia. With a critically low sodium of 115 mEq/L, 3% sodium chloride, a hypertonic saline solution, is indicated to rapidly but carefully raise serum sodium levels. Hypertonic saline draws water out of cells and into the intravascular space, correcting the dangerous sodium deficit.
Why the other options are incorrect:
A. Dextrose 5% in 0.45% sodium chloride This is a hypotonic solution that would further dilute the serum sodium and worsen the hyponatremia, making it contraindicated in this client.
C. 0.9% sodium chloride Normal saline is an isotonic solution that may be used for mild hyponatremia but is insufficient to correct a critically low sodium of 115 mEq/L. Hypertonic saline is required for severe symptomatic hyponatremia.
D. Dextrose 5% in 0.9% sodium chloride While this solution contains sodium, the dextrose component is metabolized to free water, effectively making it a hypotonic solution that would not adequately raise sodium levels and could worsen the condition.
A nurse is providing teaching to a client about hypothyroidism. Which of the following potentially fatal conditions associated with hypothyroidism will the nurse include?
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Hashimoto's disease
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Sjogren's syndrome
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Myxedema coma
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Goiters
Explanation
Myxedema coma is a rare but life-threatening complication of severe untreated or undertreated hypothyroidism. It is characterized by extreme hypothermia, altered mental status, respiratory depression, bradycardia, and hypotension, and carries a high mortality rate if not recognized and treated promptly with thyroid hormone replacement and supportive care.
Why the other options are incorrect:
A. Hashimoto's disease Hashimoto's thyroiditis is an autoimmune condition that is actually the most common cause of hypothyroidism rather than a complication of it. While it leads to thyroid dysfunction, it is not itself a potentially fatal complication of hypothyroidism.
B. Sjogren's syndrome Sjogren's syndrome is an autoimmune disorder primarily affecting moisture-producing glands, causing dry eyes and dry mouth. While it can coexist with other autoimmune conditions, it is not a complication of hypothyroidism and is not potentially fatal in this context.
D. Goiters A goiter is an enlargement of the thyroid gland that can occur in hypothyroidism due to excess TSH stimulation. While a large goiter can cause compressive symptoms affecting the airway, a goiter itself is not classified as a potentially fatal complication of hypothyroidism in the same category as myxedema coma.
A nurse is assessing a child who has attention-deficit/hyperactivity disorder (ADHD). Which of the following findings should the nurse expect?
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Aversion to being touched
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Childhood obesity
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Impulsive actions
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Lethargy
Explanation
Correct Answer: (C) Impulsive actions
Impulsivity is one of the three core symptom categories of ADHD, along with inattention and hyperactivity. Children with ADHD frequently act without thinking, interrupt others, have difficulty waiting their turn, and engage in risky behaviors without considering consequences. Impulsive actions are a hallmark and expected clinical finding in ADHD.
Why the other options are incorrect:
Aversion to tactile stimulation is more commonly associated with sensory processing disorders or autism spectrum disorder, not ADHD. While ADHD and autism can coexist, aversion to being touched is not a defining feature of ADHD.
While some research suggests a association between ADHD and obesity related to impulsive eating behaviors, childhood obesity is not a clinical manifestation or expected assessment finding of ADHD itself. It is not among the diagnostic criteria for the disorder.
Lethargy, or abnormal fatigue and decreased activity, is the opposite of what is expected in ADHD. Children with ADHD typically present with hyperactivity, restlessness, and excessive energy rather than lethargy.
A nurse is providing care for a client who has hyperosmolar hyperglycemic syndrome (HHS). Which of the following is a clinical manifestation of HHS?
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Insulin resistance
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Hypervolemia
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Ketosis
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Metabolic acidosis
Explanation
Correct Answer: (A) Insulin resistance
HHS is characterized by severe hyperglycemia resulting from relative insulin deficiency and insulin resistance, leading to hyperosmolarity without significant ketoacidosis.
Why Other Options are Incorrect:
B. Hypervolemia HHS causes profound dehydration and hypovolemia due to osmotic diuresis from severe hyperglycemia, not fluid excess.
C. Ketosis Unlike diabetic ketoacidosis (DKA), HHS does not typically involve significant ketone production because enough residual insulin exists to prevent ketogenesis.
D. Metabolic acidosis Significant metabolic acidosis is a feature of DKA, not HHS. HHS presents with minimal to no ketoacidosis.
Nurses' Notes
Client is alert and oriented x3. Reports being at school earlier this morning and suddenly felt faint and the next thing they knew, they were in an ambulance. Wearing layered, baggy clothing, and reports being cold. States increased levels of anxiety about missing school. Politely refuses offer of something to eat or drink, commenting "I'm not hungry."
Physical Examination
Client presents with a very thin appearance. Height is 5 feet 3 inches tall and weighs 40.1 kg (88 lb). Denies shortness of breath or physical pain. Neurological exam findings are within expected reference range. Skin is dry and appears slightly yellow. Denies current lightheadedness or dizziness. Gait is steady with even pace.
A nurse is assessing the client for manifestations of anorexia nervosa. Which of the following findings should the nurse expect? (Select all that apply.)
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Client's hair appears brittle and thin.
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Client comments that they are too thin and needs to gain weight.
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Client reports consuming around 600 calories each day.
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Client has soft, unpigmented hair on arms.
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Client reports preoccupation with thoughts about food.
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Client voices being "too tired" and lacks interest in daily workouts at the gym.
Explanation
Correct Answers: (A) Client's hair appears brittle and thin, (C) Client reports consuming around 600 calories each day, (D) Client has soft, unpigmented hair on arms, (E) Client reports preoccupation with thoughts about food.
Brittle and thin hair is a classic physical manifestation of anorexia nervosa resulting from severe malnutrition and protein deficiency. The lack of essential nutrients impairs hair follicle function, leading to hair thinning and breakage.
Consuming approximately 600 calories per day represents severe caloric restriction well below normal daily requirements. This extreme limitation of food intake is a defining behavioral characteristic of anorexia nervosa and is consistent with the client's very low weight of 40.1 kg.
Soft, unpigmented hair on the arms, known as lanugo, is a classic physical finding in anorexia nervosa. The body grows this fine downy hair as a physiological response to severe malnutrition in an attempt to conserve body heat due to the loss of insulating body fat.
Preoccupation with thoughts about food is a hallmark psychological manifestation of anorexia nervosa. Despite severely restricting intake, clients with anorexia are often consumed by thoughts about food, calories, and eating while simultaneously refusing to consume adequate nutrition.
Why the other options are incorrect:
Clients with anorexia nervosa typically have a severely distorted body image and perceive themselves as overweight or fat despite being dangerously underweight. Acknowledging being too thin and needing to gain weight reflects accurate body perception, which is not characteristic of anorexia nervosa.
Clients with anorexia nervosa typically engage in excessive compulsive exercise as a means of burning calories and controlling weight. Expressing disinterest in exercise is inconsistent with the typical behavioral pattern seen in anorexia nervosa.
A nurse is caring for an infant who has diaper dermatitis. Which of the following actions should the nurse take?
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Expose the excoriated area to hot air frequently.
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Change to cloth diapers until the skin is healed.
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Apply a light layer of talcum powder with each diaper change.
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Use a moisturizer to wipe urine from the skin.
Explanation
Correct Answer: (D) Use a moisturizer to wipe urine from the skin
Using a moisturizer or barrier cream helps protect the skin by reducing direct contact with urine and stool, promoting healing of the irritated skin in diaper dermatitis.
Why Other Options are Incorrect:
A. Expose the excoriated area to hot air frequently Hot air can further dry and damage already irritated skin, worsening the condition rather than promoting healing.
B. Change to cloth diapers until the skin is healed Cloth diapers retain moisture against the skin more than disposable diapers, which can worsen diaper dermatitis rather than improve it.
C. Apply a light layer of talcum powder with each diaper change Talcum powder is not recommended for infants as it can be inhaled and cause respiratory complications, and it does not effectively treat dermatitis.
Nurse's Notes
Client admitted to the unit for a lower GI bleed. Continues to have frequent bloody stools and is scheduled for a lower endoscopy in 4 hours. The client is receiving their fourth unit of packed red blood cells. Unit of fourth packed RBCs started at a rate of 250 cc/hr. Thirty minutes after the transfusion started, client started reporting dyspnea and restlessness. Crackles auscultated in bilateral lower lobes, oxygen saturation 92% on 2L nasal cannula, and jugular vein distension noted.
Vital Signs
Temperature 37.3° C (99.1° F) Blood pressure 189/90 mm Hg Pulse rate 100/min Respiratory rate 28/min
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.
Actions to Take options: A. Administer diphenhydramine B. Administer epinephrine C. Administer furosemide D. Decrease the infusion rate E. Administer an antibiotic
Potential Condition options: A. Acute intravascular hemolytic reaction B. Transfusion-associated circulatory overload (TACO) C. Anaphylactic reaction D. Bacterial reaction
Parameters to Monitor options: A. Chills B. Weight C. Low back pain D. Intake and output E. Hives
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Administer diphenhydramine
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Administer epinephrine
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Administer furosemide
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Decrease the infusion rate
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Administer an antibiotic
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Acute intravascular hemolytic reaction
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Transfusion-associated circulatory overload (TACO)
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Anaphylactic reaction
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Bacterial reaction
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Chills
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Weight
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Low back pain
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Intake and output
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Hives
Explanation
Correct Answer: Condition — Transfusion-associated circulatory overload (TACO). Actions to Take — Administer furosemide and Decrease the infusion rate. Parameters to Monitor — Weight and Intake and output.
The client is most likely experiencing transfusion-associated circulatory overload (TACO). The clinical presentation of dyspnea, restlessness, bilateral crackles, oxygen saturation of 92%, jugular vein distension, and hypertension of 189/90 mm Hg occurring thirty minutes after a rapid blood transfusion at 250 cc/hr are classic signs of fluid overload from TACO. This client is receiving their fourth unit of packed RBCs, further increasing the risk.
Administering furosemide is the appropriate intervention for TACO as it is a loop diuretic that promotes fluid excretion, reducing the excess intravascular volume that is causing pulmonary congestion and respiratory distress.
Decreasing the infusion rate is a critical immediate action to reduce the rate at which fluid is being added to the already overloaded circulation, preventing further deterioration while continuing necessary transfusion therapy.
Monitoring weight is essential in TACO as rapid weight gain indicates fluid retention and worsening circulatory overload, guiding the effectiveness of diuretic therapy.
Monitoring intake and output provides ongoing data about fluid balance, kidney response to diuresis, and whether the interventions are effectively managing the fluid overload.
Why the other options are incorrect:
A. Administer diphenhydramine Diphenhydramine is used for mild allergic transfusion reactions presenting with urticaria. The client's presentation of pulmonary congestion and hypertension is not consistent with an allergic reaction.
B. Administer epinephrine Epinephrine is indicated for anaphylactic reactions characterized by hypotension, bronchospasm, and hives. The client has hypertension and signs of fluid overload, not anaphylaxis.
E. Administer an antibiotic Antibiotic administration is indicated for bacterial transfusion reactions, which typically present with high fever, rigors, and hypotension from septic shock. The client's presentation does not support a bacterial reaction.
A. Chills are associated with febrile non-hemolytic transfusion reactions or bacterial reactions, not TACO, and are not a relevant parameter to monitor in this scenario.
C. Low back pain is a hallmark symptom of acute hemolytic transfusion reactions caused by ABO incompatibility and is not relevant to monitoring TACO.
E. Hives are associated with allergic transfusion reactions and are not a parameter for monitoring circulatory overload.
Nurses' Notes
Day 1, 1400:
Client reports an injury to the right foot 1 week ago and that the wound is getting bigger and very painful.
Client has a history of type 1 diabetes mellitus, hypertension, left below the knee amputation, and atrial fibrillation.
The client weighs 92.5 kg (204 lbs).
Client reports throbbing pain in right foot as 4 on a scale of 0 to 10.
Client is alert and oriented to person, place, and time. PERRLA. Skin is warm and dry to touch. Capillary refill 1 second. Lungs clear bilaterally in anterior and posterior. Client reports no difficulty breathing. Abdomen soft and distended. Bowel sounds hypoactive in 2 quadrants. Pedal pulse +1 right foot. Wound to right lateral heel of foot measures 2 cm by 1 cm, irregular, with scant amount of green drainage.
Client's breath has a fruity smell and client states that they have been urinating frequently.
Day 1, 1800:
Client transferred to critical care unit.
Stimulus: 5 of 6
Click to highlight prescriptions that the nurse should perform immediately.
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Infuse 0.45% normal saline at 10 mL/kg/hr IV
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Regular insulin 0.1 unit/kg IV bolus
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Start regular insulin drip per protocol
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Collect blood and wound cultures
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Insert an indwelling urinary catheter
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Consult wound care
Explanation
Regular insulin 0.1 unit/kg IV bolus must be administered immediately as the first step in DKA management to rapidly begin lowering the critically elevated blood glucose of 354 mg/dL and suppress ongoing ketone production. The IV bolus is given before starting the continuous insulin drip.
Collecting blood and wound cultures must be done immediately and before administering any antibiotics to identify the causative organism responsible for the infected wound. Delaying cultures after antibiotic administration would compromise the accuracy of results and affect treatment decisions.
Inserting an indwelling urinary catheter is an immediate priority in DKA management to allow accurate hourly urine output monitoring, assess renal perfusion, and guide fluid resuscitation. Strict intake and output is critical in this acutely ill client.
Why the other options are incorrect:
A. Infuse 0.45% normal saline at 10 mL/kg/hr IV While IV fluid resuscitation is essential in DKA, the initial fluid of choice is 0.9% normal saline, not 0.45% normal saline. The 0.45% solution is hypotonic and is typically used later in management after initial volume resuscitation is established, making this prescription not appropriate to implement immediately as written.
C. Start regular insulin drip per protocol The insulin drip is initiated after the IV bolus dose of insulin has been given, not simultaneously. The bolus must precede the drip, so this is a subsequent action rather than an immediate one.
F. Consult wound care While wound care consultation is important for the infected diabetic foot wound, it is not an immediate life-saving intervention compared to managing the acute DKA. It is appropriate to initiate after the client's metabolic crisis is stabilized.
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