ATI RN
ATI RN Custom Exams Set 2
1. The nurse prepares to administer digoxin (Lanoxin) to a newborn with a diagnosis of heart failure and notes that the apical rate is 140 beats per minute. Which nursing action is appropriate?
- A. Hold the medication
- B. Administer the digoxin
- C. Notify the healthcare provider
- D. Recheck the apical rate in 1 hour
Correct answer: B
Rationale: An apical rate of 140 bpm is within the normal range for a newborn. Digoxin is commonly used to treat heart failure by increasing the strength and efficiency of the heart's contractions. Since the heart rate is within the normal range, there is no need to hold the medication or notify the healthcare provider. Rechecking the apical rate in an hour is unnecessary as the heart rate is not alarming. Therefore, the appropriate nursing action is to administer the digoxin.
2. The nurse is caring for a client recovering from intestinal surgery. Which assessment finding would require immediate intervention?
- A. Presence of thin pink drainage in the Jackson Pratt drain
- B. Guarding when the nurse touches the abdomen
- C. Tenderness around the surgical site during palpation
- D. Complaints of chills and feeling feverish
Correct answer: D
Rationale: Complaints of chills and feeling feverish may indicate infection, which requires immediate intervention. In this postoperative setting, the presence of thin pink drainage in the Jackson Pratt drain is expected as part of the normal healing process. Guarding when the nurse touches the abdomen and tenderness around the surgical site are common after surgery and may not require immediate intervention unless they are severe or accompanied by other concerning symptoms.
3. The nurse understands that which characteristics are of anthrax? Select all that apply.
- A. Cutaneous lesions become a black eschar and flu-like symptoms are a sign of pulmonary anthrax
- B. Cutaneous lesions become a black eschar
- C. Gastrointestinal anthrax causes blood anthrax
- D. Flu-like symptoms are a sign of pulmonary anthrax
Correct answer: A
Rationale: The correct characteristics of anthrax are that cutaneous anthrax causes black eschar lesions, and flu-like symptoms are typical of pulmonary anthrax. Choice B is incorrect because it only includes information about cutaneous anthrax lesions but doesn't cover the flu-like symptoms of pulmonary anthrax. Choice C is incorrect as gastrointestinal anthrax does not cause 'blood anthrax,' it causes symptoms like severe abdominal pain, vomiting, and diarrhea. Choice D is incorrect as flu-like symptoms are associated with pulmonary anthrax, not with gastrointestinal anthrax.
4. 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 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: Choice D is the correct answer because a swollen and thickened spermatic cord could indicate testicular torsion, which is a surgical emergency. Testicular torsion occurs when the spermatic cord twists, cutting off the blood supply to the testicle. This condition requires immediate intervention to prevent testicular damage. Choices A, B, and C do not present findings that suggest a surgical emergency requiring immediate intervention.
5. Listed below are five categories that identify the responsibilities of the practical nurse manager in personnel management. Which of these categories is most appropriate for the task of 'listening and responding to soldiers' suggestions and complaints'?
- A. Accountability
- B. Personal/professional development
- C. Individual training
- D. Military appearance/physical condition
Correct answer: A
Rationale: The correct answer is A. Accountability in personnel management involves being answerable for one's actions and decisions, which includes listening to and addressing the suggestions and complaints of soldiers. This category focuses on the responsibility and answerability aspect of the nurse manager's role. Choices B, C, and D are incorrect because personal/professional development is about growth and improvement, individual training pertains to specific skill development, and military appearance/physical condition relates to the physical presentation and fitness levels, none of which directly address the task of listening and responding to soldiers' suggestions and complaints.
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