a nurse is reviewing the medical record of a client who has a new prescription for ceftriaxone the nurse should identify which of the following findin
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Nursing Elites

ATI RN

ATI Exit Exam 2024

1. A healthcare professional is reviewing the medical record of a client who has a new prescription for ceftriaxone. The healthcare professional should identify which of the following findings as a contraindication to this medication?

Correct answer: C

Rationale: The correct answer is C: Penicillin allergy. Penicillin allergy is a contraindication for ceftriaxone because both medications are beta-lactam antibiotics. Seizure disorder (choice A), hypertension (choice B), and hyperlipidemia (choice D) are not contraindications for ceftriaxone and do not directly affect the use of this antibiotic.

2. A nurse is planning care for a client who is 1 day postoperative following a total knee arthroplasty. Which of the following interventions should the nurse include?

Correct answer: C

Rationale: Encouraging the client to ambulate as soon as possible is essential in preventing complications like deep vein thrombosis post knee arthroplasty. While keeping the affected leg elevated and applying ice packs can be beneficial in certain situations, early ambulation takes precedence in this case. Performing range-of-motion exercises hourly may not be necessary and could potentially cause more harm than good if not done correctly or excessively.

3. How should fluid balance be monitored in a patient receiving diuretics?

Correct answer: A

Rationale: Corrected Question: To assess fluid balance in a patient receiving diuretics, monitoring daily weight is the most accurate method. This is because diuretics primarily affect fluid levels in the body, leading to changes in weight due to fluid loss. While monitoring intake and output, checking for edema, and monitoring blood pressure are important aspects of patient care, they do not provide as direct and accurate information about fluid balance as daily weight monitoring specifically in patients on diuretics.

4. A client who has a new prescription for spironolactone is being taught by a nurse. Which of the following client statements indicates an understanding of the teaching?

Correct answer: D

Rationale: The correct answer is D because clients taking spironolactone should have their potassium levels checked regularly. Spironolactone is a potassium-sparing diuretic, meaning it helps the body retain potassium and can lead to hyperkalemia if levels become too high. Choices A, B, and C are incorrect because avoiding foods high in potassium, sodium, or monitoring blood pressure are not specific to the teaching related to spironolactone.

5. A nurse is assessing a client who has diabetes mellitus and is experiencing hyperglycemia. Which of the following findings should the nurse expect?

Correct answer: A

Rationale: Polyuria is the excessive production of urine and is a common finding in clients with hyperglycemia due to increased glucose levels. High blood sugar levels lead to the body trying to eliminate the excess glucose through urine, resulting in increased urination. Hypoglycemia (choice B) is low blood sugar and is not typically associated with hyperglycemia. Diaphoresis (choice C) is excessive sweating and is not a direct symptom of hyperglycemia. Tachycardia (choice D) is increased heart rate and is not a primary finding in hyperglycemia.

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