a nurse is reviewing the medical record of a client who has hypothyroidism which of the following findings should the nurse expect
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Nursing Elites

ATI RN

ATI Exit Exam 2023

1. A nurse is reviewing the medical record of a client who has hypothyroidism. Which of the following findings should the nurse expect?

Correct answer: A

Rationale: The correct answer is A. Weight gain can indicate myxedema, which is a symptom commonly seen in hypothyroidism. Exophthalmos (choice B) is actually a characteristic finding of hyperthyroidism, not hypothyroidism. Tachycardia (choice C) and heat intolerance (choice D) are also more indicative of hyperthyroidism rather than hypothyroidism.

2. A nurse is preparing to administer a unit of packed RBCs to a client. Which of the following actions should the nurse take first?

Correct answer: A

Rationale: The correct first action for the nurse to take when preparing to administer a unit of packed RBCs is to check the client's identification band. This step is crucial to ensure that the correct blood is administered to the right client, preventing any errors or adverse reactions. Verifying the provider's prescription, priming the IV tubing, and obtaining the client's vital signs are important steps in the process but should follow the initial identification check to prioritize patient safety.

3. A charge nurse on a medical-surgical unit is planning assignments for a licensed practical nurse (LPN) who has been sent from the unit due to a staffing shortage. Which of the following clients should the nurse delegate to the LPN?

Correct answer: C

Rationale: The correct answer is C because a client who is postoperative following a bowel resection with an NG tube can be delegated to an LPN as this involves routine postoperative care. Option A involves administering packed RBCs which requires assessment and monitoring for potential adverse reactions, not suitable for delegation to an LPN. Option B requires neurological assessment and close monitoring due to the concussion, which is beyond the scope of an LPN. Option D involves a client with a recent fracture and shortness of breath, which requires urgent assessment and intervention beyond the LPN's scope of practice.

4. How should a healthcare professional assess for infection in a patient post-surgery?

Correct answer: A

Rationale: When assessing for infection in a patient post-surgery, checking the surgical site is crucial. Changes in the appearance of the surgical site, such as redness, swelling, warmth, or drainage, can indicate an infection. While checking for fever (Choice B) is also important as it can be a sign of infection, it is a more general symptom and may not always be present. Checking for abnormal breath sounds (Choice C) and skin color (Choice D) are not typically direct indicators of infection in a post-surgery patient.

5. A nurse is receiving change-of-shift report for a group of clients. Which of the following clients should the nurse plan to assess first?

Correct answer: B

Rationale: The correct answer is B because a new onset of tachypnea can indicate a respiratory complication, which requires immediate assessment. Sinus arrhythmia, epidural analgesia with weakness, and a hemoglobin A1C level of 6.8% in a client with diabetes do not pose immediate life-threatening concerns that require urgent assessment compared to the potential respiratory issues associated with tachypnea.

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