ATI RN
ATI Leadership Proctored Exam 2023
1. Which statement to a patient newly diagnosed with type 2 diabetes is correct?
- A. Complications of type 2 diabetes are less serious than those of type 1 diabetes.
- B. Insulin is not used to control blood glucose in patients with type 2 diabetes.
- C. Changes in diet and exercise may control blood glucose levels in type 2 diabetes.
- D. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma.
Correct answer: C
Rationale: Choice C is the correct statement to convey to a patient newly diagnosed with type 2 diabetes. Lifestyle modifications, such as changes in diet and exercise, are essential components of managing type 2 diabetes. These changes can help control blood glucose levels and improve overall health. Options A, B, and D are incorrect statements. While complications of type 2 diabetes can be serious, they are different from those of type 1 diabetes. Some patients with type 2 diabetes may require insulin therapy, but it is not true that insulin is not used at all. Type 2 diabetes is not typically diagnosed during a hyperglycemic coma, as it is usually identified through routine screenings or symptoms unrelated to a coma.
2. 12. A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time will it be most important for the nurse to monitor for symptoms of hypoglycemia?
- A. 10:00 AM
- B. 12:00 PM
- C. 2:00 PM
- D. 4:00 PM
Correct answer: A
Rationale: After receiving aspart (NovoLog) insulin, which has a rapid onset, it is crucial to monitor the patient for symptoms of hypoglycemia during the peak action time. Typically, the peak action of aspart insulin occurs around 2 hours after administration. Therefore, the nurse should be most vigilant for hypoglycemia symptoms at 10:00 AM. Choice B (12:00 PM) is incorrect as it falls after the expected peak action time. Choices C (2:00 PM) and D (4:00 PM) are also incorrect because the peak action time of aspart insulin typically occurs earlier, around 2 hours post-administration.
3. The healthcare provider suspects the Somogyi effect in a 50-year-old patient whose 6:00 AM blood glucose is 230 mg/dL. Which action will the nurse teach the patient to take?
- A. Avoid snacking at bedtime.
- B. Increase the rapid-acting insulin dose.
- C. Check the blood glucose during the night.
- D. Administer a larger dose of long-acting insulin.
Correct answer: C
Rationale: The Somogyi effect, also known as rebound hyperglycemia, occurs due to an excessive insulin dose at night, leading to hypoglycemia in the early morning hours. To address this, the nurse should instruct the patient to check their blood glucose during the night to determine if hypoglycemia is present, which triggers the rebound hyperglycemia. By monitoring blood glucose levels during the night, the patient can identify if adjustments are needed to prevent this phenomenon and maintain stable glucose levels. Choices A, B, and D are incorrect. Avoiding snacking at bedtime, increasing rapid-acting insulin dose, or administering a larger dose of long-acting insulin are not appropriate actions to manage the Somogyi effect. Checking blood glucose during the night is crucial to identify and prevent the rebound hyperglycemia characteristic of this phenomenon.
4. A 54-year-old patient is admitted with diabetic ketoacidosis. Which admission order should the nurse implement first?
- A. Infuse 1 liter of normal saline per hour.
- B. Give sodium bicarbonate 50 mEq IV push.
- C. Administer regular insulin 10 U by IV push.
- D. Start a regular insulin infusion at 0.1 units/kg/hr.
Correct answer: A
Rationale: In a patient admitted with diabetic ketoacidosis, the initial priority is to address dehydration and electrolyte imbalances. Infusing 1 liter of normal saline per hour helps correct hypovolemia and restore electrolyte balance, making it the first essential step in managing diabetic ketoacidosis. Sodium bicarbonate is not routinely recommended in treating diabetic ketoacidosis and should not be given routinely as it may worsen the acidosis. Administering regular insulin and starting an insulin infusion are important but should come after fluid resuscitation to stabilize the patient's condition.
5. After change-of-shift report, which patient should the nurse assess first?
- A. 19-year-old with type 1 diabetes who was admitted with possible dawn phenomenon
- B. 35-year-old with type 1 diabetes whose most recent blood glucose reading was 230 mg/dL
- C. 60-year-old with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa
- D. 68-year-old with type 2 diabetes who has severe peripheral neuropathy and complains of burning foot pain
Correct answer: C
Rationale: The patient with hyperosmolar hyperglycemic syndrome who presents with poor skin turgor and dry oral mucosa requires immediate attention. These signs indicate severe dehydration and potential electrolyte imbalances, which can lead to serious complications. Assessing this patient first allows for prompt intervention and monitoring to stabilize their condition. Choice A is less urgent as the patient has possible dawn phenomenon, which is a common early-morning rise in blood glucose levels. Choice B, with a blood glucose reading of 230 mg/dL, indicates hyperglycemia but does not present with signs of severe dehydration like the patient in choice C. Choice D, with peripheral neuropathy and foot pain, is important but not as urgent as addressing severe dehydration and electrolyte imbalances in the patient with hyperosmolar hyperglycemic syndrome.
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