ATI RN
ATI Leadership Proctored Exam 2019
1. A 48-year-old male patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). The nurse will plan to teach the patient about
- A. self-monitoring of blood glucose
- B. using low doses of regular insulin
- C. lifestyle changes to lower blood glucose
- D. effects of oral hypoglycemic medications
Correct answer: C
Rationale: When a patient has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L), indicating prediabetes, the initial approach is focused on lifestyle modifications to lower blood glucose levels. These changes may include dietary adjustments, increased physical activity, and weight management. Self-monitoring of blood glucose, insulin therapy, and oral hypoglycemic medications are not typically the first-line interventions for patients with prediabetes. Educating the patient about lifestyle changes to lower blood glucose is the most appropriate action at this stage.
2. Which patient action indicates a good understanding of the nurse�s teaching about the use of an insulin pump?
- A. The patient programs the pump for an insulin bolus after eating
- B. The patient changes the location of the insertion site every week
- C. The patient takes the pump off at bedtime and starts it again each morning.
- D. The patient plans for a diet that is less flexible when using the insulin pump.
Correct answer: A
Rationale:
3. What should the nurse do after a 36-year-old patient treated with intramuscular glucagon for hypoglycemia regains consciousness?
- A. Assess the patient for symptoms of hyperglycemia.
- B. Give the patient a snack of peanut butter and crackers.
- C. Have the patient drink a glass of orange juice or nonfat milk.
- D. Administer a continuous infusion of 5% dextrose for 24 hours.
Correct answer: B
Rationale: After a patient treated with intramuscular glucagon for hypoglycemia regains consciousness, providing a snack of peanut butter and crackers is essential to prevent another episode of hypoglycemia. Peanut butter and crackers contain a combination of protein and carbohydrates, which can help stabilize the patient's blood glucose levels. This choice is the most appropriate immediate action to prevent recurrence of hypoglycemia in this scenario. Assessing for symptoms of hyperglycemia (choice A) is not the immediate priority after treating hypoglycemia. While orange juice or nonfat milk (choice C) can help raise blood sugar, they lack the sustained effect of protein found in peanut butter. Administering a continuous infusion of dextrose (choice D) is excessive and not indicated after the patient has already regained consciousness.
4. A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first?
- A. Infuse dextrose 50% by slow IV push.
- B. Administer 1 mg glucagon subcutaneously.
- C. Obtain a glucose reading using a finger stick.
- D. Have the patient drink 4 ounces of orange juice.
Correct answer: C
Rationale: The correct action for the nurse to take first when a patient reports feeling lightheaded and sweaty after being weaned off an insulin drip is to obtain a glucose reading using a finger stick. This will provide crucial information on the patient's current blood glucose level, helping the nurse assess if the symptoms are due to hypoglycemia. Based on the glucose reading, appropriate interventions can be initiated, such as administering dextrose, glucagon, or oral sugars like orange juice if hypoglycemia is confirmed. However, verifying the blood glucose level is the initial step to guide subsequent actions and ensure patient safety.
5. After receiving change-of-shift report, which patient should the nurse assess first?
- A. 19-year-old with type 1 diabetes who has a hemoglobin A1C of 12%
- B. 23-year-old with type 1 diabetes who has a blood glucose of 40 mg/dL
- C. 40-year-old who is pregnant and has an oral glucose tolerance test result of 202 mg/dL
- D. 50-year-old who uses exenatide (Byetta) and is complaining of acute abdominal pain
Correct answer: B
Rationale: The correct answer is B because the patient with a blood glucose level of 40 mg/dL (hypoglycemia) needs immediate attention. Hypoglycemia is an emergency situation that requires prompt intervention to prevent adverse effects such as seizures or loss of consciousness. Assessing and managing this patient first is crucial to prevent further deterioration. Choices A, C, and D do not present immediate life-threatening situations requiring urgent intervention like severe hypoglycemia does. While a high hemoglobin A1C level (choice A), an abnormal oral glucose tolerance test result (choice C), and acute abdominal pain (choice D) are important issues, they do not pose an immediate threat to the patient's life compared to severe hypoglycemia.
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