ATI RN
ATI RN Exit Exam Quizlet
1. A nurse is assessing a client who has been taking lithium for bipolar disorder. Which of the following findings should the nurse report to the provider?
- A. Tremors
- B. Increased thirst
- C. Weight gain
- D. Diarrhea
Correct answer: A
Rationale: Corrected Rationale: Tremors can indicate lithium toxicity, which should be reported to the provider for further evaluation. Tremors are a significant sign of lithium toxicity and can lead to serious complications if not addressed promptly. Increased thirst, weight gain, and diarrhea are common side effects of lithium but are not typically indicative of toxicity. Therefore, the nurse should prioritize reporting tremors as it requires immediate attention.
2. A nurse is caring for a client who is receiving oxytocin IV for augmentation of labor. The client's contractions are occurring every 45 seconds with a nine-second duration, and the fetal heart rate is 170 to 180 beats per minute. Which of the following actions should the nurse take?
- A. Discontinue oxytocin infusion
- B. Increase oxytocin infusion
- C. Decrease oxytocin infusion
- D. Maintain oxytocin infusion
Correct answer: A
Rationale: In this scenario, the client is experiencing frequent contractions with a short duration and an elevated fetal heart rate, indicating potential fetal distress. Discontinuing the oxytocin infusion is crucial to prevent further complications and restore normal fetal parameters. Increasing or maintaining the oxytocin infusion could exacerbate the situation, leading to more distress for the fetus. Decreasing the oxytocin infusion may not be sufficient to address the current issue and could delay the improvement of fetal well-being.
3. A nurse is assessing a client who is receiving furosemide for heart failure. Which of the following findings is the priority to report to the provider?
- A. Blood pressure of 98/58 mm Hg
- B. Urine output of 50 mL/hr
- C. Serum potassium level of 3.2 mEq/L
- D. Weight loss of 0.5 kg (1.1 lb) in 24 hours
Correct answer: C
Rationale: The correct answer is C. A serum potassium level of 3.2 mEq/L indicates hypokalemia, a potential complication of furosemide therapy, and should be reported immediately. Hypokalemia can lead to serious cardiac dysrhythmias. Choices A, B, and D are important assessments but are not as critical as managing serum potassium levels in a client receiving furosemide for heart failure.
4. A client with a new diagnosis of type 1 diabetes mellitus is being taught by a nurse. Which of the following client statements indicates an understanding of the teaching?
- A. I will check my blood glucose levels only when I feel sick.
- B. I will inject insulin in the same spot each time.
- C. I will rotate injection sites within the same anatomical region.
- D. I will inject insulin only if my blood glucose level is above 200 mg/dL.
Correct answer: C
Rationale: The correct answer is C. Clients with type 1 diabetes should rotate injection sites within the same anatomical region to prevent lipodystrophy. Choice A is incorrect because blood glucose levels should be checked regularly, not only when feeling sick. Choice B is incorrect as injecting insulin in the same spot each time can lead to lipodystrophy. Choice D is incorrect as insulin injections are usually required based on meal schedules and blood glucose levels, not just when levels are above 200 mg/dL.
5. What is the first action to take when a patient experiences a seizure?
- A. Protect the patient from injury
- B. Administer oxygen
- C. Administer IV fluids
- D. Administer anti-seizure medication
Correct answer: A
Rationale: The first action to take when a patient experiences a seizure is to protect the patient from injury. This is crucial to prevent harm during the seizure. Administering oxygen, IV fluids, or anti-seizure medication may be necessary based on the patient's condition, but ensuring their safety by removing harmful objects, cushioning their head, and keeping the area clear is the immediate priority. Administering oxygen, IV fluids, or medication would come after ensuring the patient's safety.
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