NGN ATI RN Comprehensive 2023 A Version 1 | Questions and Verified Answers| 100% Correct| A Grade
QUESTION
A nurse is teaching a patient who has a
... [Show More] new prescription for estradiol. For which of the following adverse effects of this medication should the nurse instruct the patient to monitor and report to the provider?
A. Hypotension
B. Headaches
C. Bruising
D. Oliguria
Answer:
B. Headaches
-The nurse should instruct the patient to monitor for and report headaches. Headaches can be an indication of a thromboembolic stroke because estradiol increases the risk for adverse cardiovascular events.
-Other symptoms to report include HTN, swelling/tenderness of an extremity, fluid retention, or genitourinary candidiasis.
QUESTION
A nurse is caring for a patient who has bipolar disorder. The nurse observes that the patient is becoming increasingly restless. The patient is pacing the unit and speaking rapidly, frequently using profanities and sexual references. Which of the following actions should the nurse take first?
A. Provide an opportunity for the patient to express their feelings.
B. Move the patient to a quiet place away from others.
C. State expectations that set limits on the patient's behavior.
D. Administer a PRN dose of haloperidol to calm the patient.
Answer:
B. Move the patient to a quiet place way from others.
-The patient's behavior indicates the greatest risk is injury to others. Therefore, the first action the nurse should take is to prevent harm to other patients by moving this patient to a quiet place away from others.
QUESTION
A nurse is caring for a patient who is in labor at 39wks of gestation. During the second stage of labor, the nurse observes early decels on the monitor tracing. Which of the following actions should the nurse take?
A. Continue observing the FHR.
B. Assist the patient to a knee-chest position.
C. Prepare the patient for continuous internal monitoring.
D. Prepare for an emergency C-sect
Answer:
A. Continue observing the FHR
-Early decels indicate the progression of labor and are an expected finding. The nurse should continue to monitor the fetus by observing the FHR and tracing.
-Assist the patient into a knee-chest position if the umbilical cord prolapses.
-No indication for internal monitoring.
-Prepare for an emergency c-sect if the monitor indicates late/variable decels, despite interventions.
QUESTION
A nurse is creating a plan of care for a patient who has a left-sided weakness following a stroke. Which of the following interventions should the nurse include in the plan?
A. Massage bony prominences on the patient's left side.
B. Support the patient's left arm on a pillow while sitting.
C. Position the bedside table on the patient's left side.
D. Place the patient's cane on their left side while ambulating.
Answer:
B. Support the patient's left arm on a pillow while sitting.
-Support the affected arm to prevent the extremity from hanging freely because this can cause shoulder subluxation.
-Avoid massaging bony prominences because it can cause deep tissue trauma.
-Position the table on the patient's unaffected side so items are within reach.
-Teach patient to hold the cane on the stronger side of their body.
QUESTION
A nurse is providing teaching about home care to the parents of a child who has autism spectrum disorder. Which of the following instructions should the nurse include?
A. Maintain a flexible daily schedule for the child.
B. Use a reward system to modify the child's behavior.
C. Provide a variety of family member to care for the child.
D. Administer alprazolam PRN to reduce the child's anxiety.
Answer:
B. Use a reward system to modify the child's behavior.
-Children who have autism spectrum disorder respond well to a reward system, which can provide structure and expectations for behavior.
-Children with autism respond better to a familiar daily schedule and having familiar caregivers. Usually are prescribed SSRIs to improve mood and reduce anxiety.
QUESTION
A nurse is preparing a sterile field to perform a sterile dressing change. Which of the following interventions should the nurse use to maintain surgical sterile technique?
A. Hold hands folded below the waist after donning sterile gloves.
B. Pick up and pour solutions with the palm of the hand covering bottle labels.
C. Keep sterile items within a 1.3 cm (0.5 in) border of the sterile drape.
D. Maintain sterile objects within the line of vision.
Answer:
D. Maintain sterile objects within the line of vision.
-Objects out of the line of vision are not considered sterile. Therefore, the nurse should keep sterile objects in direct sight to maintain surgical asepsis.
-Sterile technique includes holding hands away from body and above waist level. Items should be kept at least 2.5 cm (1 in) away from the border.
-The nurse should use this technique to prevent the solution from running down the label and obscuring the writing, but this action does not maintain sterile technique.
QUESTION
A nurse is reviewing the lab results of a toddler who has hemophilia A. Which of the following aPTT values should the nurse expect?
(Normal: 30-40 sec)
A. 11 seconds
B. 22 seconds
C. 30 seconds
D. 45 seconds
Answer:
D. 45 seconds
-A manifestation of hemophilia A is a longer clotting time.
QUESTION [Show Less]