ATI- RN Concept-Based Assessment Level 2 & 3 with NGN
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Free ATI- RN Concept-Based Assessment Level 2 & 3 with NGN Questions
A nurse is teaching a client who is at 30 weeks of gestation and has coarctation of the aorta. Which of the following statements should the nurse include regarding this congenital heart defect?
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"You have an increased risk of developing preeclampsia."
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"You will be placed in a supine position during labor."
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"You will receive terbutaline if you experience preterm labor."
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"You will be encouraged to receive epidural anesthesia during labor."
Explanation
The Correct Answer is:
A. "You have an increased risk of developing preeclampsia."
Detailed Explanation:
Coarctation of the aorta is a congenital narrowing of the aorta that leads to increased arterial pressure in the upper body and reduced blood flow to the lower extremities. Pregnant clients with this condition are at a higher risk for hypertension and preeclampsia due to increased vascular resistance and cardiac workload. They require close blood pressure monitoring throughout pregnancy. Supine positioning is avoided as it decreases venous return, terbutaline is contraindicated in cardiac disorders, and epidural anesthesia must be used cautiously but is not the key teaching point.
A nurse is providing preoperative teaching for a client who is scheduled for a bilateral tubal ligation. Which of the following statements should the nurse include in the teaching?
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"You will no longer feel ovulation pain."
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"You should expect a heavier menstrual period."
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"You should expect changes in your hormones."
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"Your sexual function will be unaffected."
Explanation
The Correct Answer is:
D. "Your sexual function will be unaffected."
Detailed Explanation:
A bilateral tubal ligation (BTL) is a permanent method of contraception that involves occluding or removing sections of the fallopian tubes to prevent fertilization. The procedure does not affect hormone production, libido, or sexual pleasure, as the ovaries and hormone levels remain unchanged. Clients will continue to ovulate and menstruate normally, but the released ova are reabsorbed by the body.
The nurse should emphasize that this is a permanent form of birth control and reversal is often difficult or unsuccessful. Clients should use contraception until surgery is confirmed effective and be informed that BTL does not protect against sexually transmitted infections (STIs). Menstrual cycles may become slightly lighter or remain unchanged, but not heavier.
A nurse is planning care for a client who is experiencing moderate vaginal bleeding due to a placental abruption. Which of the following interventions should the nurse include in the plan?
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Check cervical dilation every 2 hr.
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Obtain vital signs every 4 hr.
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Initiate an IV with an 18-gauge catheter.
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Monitor FHR hourly.
Explanation
The Correct Answer is:
C. Initiate an IV with an 18-gauge catheter.
Detailed Explanation:
Placental abruption involves premature separation of the placenta from the uterine wall, leading to maternal hemorrhage and potential fetal distress. The priority intervention is to establish rapid IV access using a large-bore (18-gauge or larger) catheter to enable fluid resuscitation, blood transfusions, and medication administration. Maintaining hemodynamic stability is essential to prevent hypovolemic shock.
Frequent vital signs (every 15 minutes or as indicated) and continuous fetal heart rate monitoring are required to assess for signs of maternal or fetal compromise. Repeated cervical exams are avoided because they can worsen bleeding. This situation is a medical emergency that requires prompt stabilization and possible delivery, depending on the severity of the abruption and the fetal status.
A nurse in a long-term care facility is admitting a client who has multiple sclerosis. Which of the following findings is the priority for the nurse to address?
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Decreased problem-solving ability.
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Increased nystagmus.
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Increased confusion.
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Decreased hearing acuity.
Explanation
The Correct Answer is:
C. Increased confusion.
Detailed Explanation:
For a client with multiple sclerosis, increased confusion is the priority finding because it can indicate hypoxia, infection, or an adverse medication effect, all of which require immediate intervention to prevent deterioration. While other findings like nystagmus, decreased problem-solving ability, and hearing loss are common or expected in MS due to demyelination, acute confusion suggests a potentially reversible or life-threatening complication. The nurse should promptly assess vital signs, oxygenation, and infection indicators to determine the underlying cause and intervene accordingly.
A nurse is assessing a toddler following a report of child maltreatment. Which of the following findings should the nurse identify as a possible indication of physical neglect?
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Multiple bruises on the lower legs
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Parent verbally degrades the child
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Fearful when hearing other children cry
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Lack of current immunizations
Explanation
The Correct Answer is:
D. Lack of current immunizations.
Detailed Explanation:
Physical neglect occurs when a caregiver fails to provide the basic physical needs necessary for a child’s health and development, such as adequate food, clothing, shelter, medical care, and safety. A lack of current immunizations reflects failure to obtain necessary healthcare and preventive services, which is a key indicator of neglect.
Other signs of physical neglect may include poor hygiene, malnutrition, untreated medical conditions, inappropriate clothing for the weather, or frequent absences from school. The nurse should document all findings objectively and follow mandatory reporting laws by notifying child protective services for further evaluation and intervention to ensure the child’s safety and well-being.
A nurse is assessing a newborn who is 4 hr old. Which of the following findings should the nurse expect?
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Generalized petechiae
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Blue hands and feet
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Flaring of the nares
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Bulging fontanels
Explanation
The Correct Answer is:
B. Blue hands and feet.
Detailed Explanation:
It is normal for newborns in the first few hours of life to have acrocyanosis, which is bluish discoloration of the hands and feet due to immature peripheral circulation and a transitional adjustment to extrauterine life. This finding typically resolves within the first 24 hours.
Generalized petechiae may indicate clotting disorders or infection, flaring of the nares is a sign of respiratory distress, and bulging fontanels suggest increased intracranial pressure—all of which are abnormal findings requiring further evaluation. Therefore, blue hands and feet is the expected normal finding in a healthy 4-hour-old newborn.
A nurse is reviewing the laboratory report of an 8-year-old child who has nephrotic syndrome. Which of the following laboratory results should the nurse report to the provider?
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Protein 2 g/dL
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Cholesterol 170 mg/dL
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Platelet count 350,000/mm³
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Sodium 140 mEq/L
Explanation
The Correct Answer is:
A. Protein 2 g/dL.
Detailed Explanation:
A serum protein level of 2 g/dL is critically low and indicates severe hypoalbuminemia, a hallmark finding in nephrotic syndrome. This condition occurs due to increased glomerular permeability, allowing significant protein loss in the urine (proteinuria). The resulting low serum protein causes decreased oncotic pressure, leading to edema and fluid retention.
In nephrotic syndrome, total cholesterol levels are typically elevated, not low, due to altered lipid metabolism. The other values listed—platelet count and sodium—are within normal limits and do not require immediate provider notification. Reporting and addressing low serum protein is essential to initiate or adjust treatment, such as albumin replacement or corticosteroid therapy.
A nurse is teaching a client who has multiple sclerosis and a new prescription for interferon-beta-1a. Which of the following statements should the nurse make?
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"This medication might cause flu-like symptoms."
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"This medication might make you feel euphoric."
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"This medication is taken orally every morning."
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"This medication can cause excess hair growth."
Explanation
The Correct Answer is:
A. "This medication might cause flu-like symptoms."
Detailed Explanation:
Interferon-beta-1a is an immunomodulator used to reduce the frequency and severity of multiple sclerosis (MS) relapses. A common side effect is the development of flu-like symptoms—such as fever, chills, muscle aches, and malaise—typically occurring after injections, especially early in therapy. These symptoms can be minimized by administering the medication at bedtime and taking acetaminophen or ibuprofen beforehand. The drug is given by subcutaneous or intramuscular injection, not orally. It does not cause euphoria or excess hair growth, as those effects are unrelated to its mechanism of action.
A nurse is preparing to perform a capillary blood glucose test for a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take first?
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Hold the client's finger in a dependent position.
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Place the lancet on the side of the selected finger.
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Wipe away the first drop of blood.
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Cleanse the client's finger with an antiseptic swab.
Explanation
The Correct Answer is:
D. Cleanse the client's finger with an antiseptic swab.
Detailed Explanation:
The first action the nurse should take before performing a capillary blood glucose test is to cleanse the client’s finger with an antiseptic swab to reduce the risk of infection. After cleansing, the finger should be held in a dependent position to promote blood flow, then punctured on the side (not the center) to minimize discomfort. The first drop of blood is wiped away because it may contain tissue fluid that can alter the test result.
A client with a hearing impairment and a new hearing aid is receiving discharge education from a nurse. Which of the following client statements indicates an understanding of the teaching?
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"If my hearing aid gets dirty, I can clean it with alcohol swabs."
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"I will rotate the earmold forward when I insert my hearing aid."
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"If my hearing aid whistles, I should change the battery."
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"I should turn the hearing aid on before I insert it."
Explanation
The Correct Answer is:
B. "I will rotate the earmold forward when I insert my hearing aid."
Detailed Explanation:
When inserting a hearing aid, the client should rotate the earmold slightly forward to ensure a proper fit and seal in the ear canal. This technique helps prevent discomfort and reduces the risk of whistling or feedback noise. The hearing aid should be turned off before insertion and cleaned with a soft, dry cloth rather than alcohol or water, which can damage the device. Whistling is usually caused by improper placement, not by a low battery.
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