ATI RN
ATI RN Custom Exams Set 4
1. During a physical assessment of a newborn, what finding should the nurse prioritize reporting?
- A. Head circumference of 40 cm
- B. Chest circumference of 32 cm
- C. Acrocyanosis and edema of the scalp
- D. Heart rate of 160 bpm and respirations of 40/min
Correct answer: A
Rationale: The correct answer is A because a head circumference of 40 cm is unusually large for a newborn, which may indicate hydrocephalus or other abnormalities. Reporting this finding is crucial for further evaluation and intervention. Choices B, C, and D are not as concerning during a newborn physical assessment. A chest circumference of 32 cm is within the normal range for a newborn. Acrocyanosis and edema of the scalp are common findings in newborns and usually resolve without intervention. While a heart rate of 160 bpm and respirations of 40/min should be monitored, they are not as critical as an unusually large head circumference.
2. The system used at the division level and forward comprises six basic modules. Which module is composed of practical nurses, medical specialists, and equipment to provide medical support for minimal care patients?
- A. Treatment squad
- B. Patient Holding Squad
- C. Area Support Squad
- D. Surgical Squad
Correct answer: B
Rationale: The Patient Holding Squad is the module that is composed of practical nurses, medical specialists, and equipment to provide medical support for minimal care patients. This squad focuses on providing necessary care for patients who require minimal attention. Choices A, C, and D are incorrect because they do not specifically cater to the needs of minimal care patients. The Treatment Squad may involve more intensive procedures, the Area Support Squad focuses on broader support functions, and the Surgical Squad is specialized for surgical interventions.
3. Which medication should a patient with a history of peptic ulcer disease avoid?
- A. Acetaminophen
- B. Antacids
- C. Nonsteroidal anti-inflammatory drugs
- D. Antihistamines
Correct answer: C
Rationale: Patients with a history of peptic ulcer disease should avoid Nonsteroidal anti-inflammatory drugs (NSAIDs) because they can worsen peptic ulcers due to their effects on the stomach lining. Acetaminophen (Choice A) is a safer alternative for pain relief in such patients as it does not have the same ulcerogenic effects. Antacids (Choice B) can actually help alleviate symptoms by neutralizing stomach acid and are generally safe to use. Antihistamines (Choice D) are not known to exacerbate peptic ulcers and can be used safely for conditions like allergies.
4. The nurse is caring for a client who goes into ventricular tachycardia. Which intervention should the nurse implement first?
- A. Call a code immediately
- B. Assess the client for a pulse
- C. Begin chest compressions
- D. Continue to monitor the client
Correct answer: B
Rationale: The correct first intervention when a client goes into ventricular tachycardia is to assess for a pulse. This is crucial as the presence or absence of a pulse guides subsequent actions. Initiating chest compressions or calling a code should only be done after confirming the absence of a pulse. Continuing to monitor the client without checking for a pulse delays potentially life-saving interventions.
5. The nurse in the pediatric clinic performs a physical assessment of a 13-year-old boy. Which of the following findings by the nurse requires an immediate intervention?
- A. The adolescent complains of his scrotum aching after exercise. The nurse palpates a worm-like mass above the testes
- B. The nurse noted unilateral breast enlargement
- C. The child’s scrotum appears swollen, and a soft mass is palpated. The nurse is unable to insert a finger above the mass
- D. The child’s scrotum appears enlarged and red. The nurse palpated a thickened and swollen spermatic cord.
Correct answer: D
Rationale: A swollen and thickened spermatic cord could indicate testicular torsion, which is a surgical emergency.
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