ATI Nrg 430 Midterm a

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Sample questions from ATI Nrg 430 Midterm a

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 68-year-old client is admitted to a medical-surgical unit with pneumonia. The client is newly confused, has a temperature of 39.1 C (102.4 F), heart rate 126/min, blood pressure 86/50 mm Hg, respiratory rate 30/min, and oxygen saturation 88% on room air. Which action should the nurse take first?

   • A.Obtain a sputum specimen before administering antibiotics
   • B.Apply oxygen and activate the rapid response system
   • C.Administer the prescribed acetaminophen
   • D.Encourage oral fluids and reassess in 30 minutes

   Rationale: The client has hypoxemia, hypotension, tachycardia, and acute confusion, suggesting severe infection with possible sepsis and impaired perfusion. Applying oxygen and escalating care immediately address the life-threatening instability. Obtaining a specimen and giving acetaminophen may be appropriate later, while fluids by mouth and delayed reassessment are unsafe with this degree of instability.

2. 2.A 74-year-old client is 8 hours postoperative after hip repair on a surgical unit. The client is alert, has stable vital signs, and needs assistance transferring to a chair for the first time. Which task is appropriate for the registered nurse to delegate to an experienced unlicensed assistive personnel (UAP)?

   • A.Assess the client's pain before the transfer
   • B.Teach the client how to use the walker
   • C.Assist the client with the transfer after the RN confirms the plan
   • D.Evaluate the client's response to the prescribed analgesic

   Rationale: A trained UAP may assist with routine mobility for a stable client after the RN has assessed the client and established the plan. Pain assessment, teaching, and evaluation require nursing judgment and remain the RN's responsibility. The exam takeaway is to delegate predictable tasks, not assessment or evaluation.

3. 3.A 56-year-old client with type 1 diabetes is admitted to the emergency department with nausea, abdominal pain, and deep rapid respirations. Glucose is 548 mg/dL, potassium is 5.4 mEq/L, and arterial pH is 7.18. Which prescribed intervention should the nurse implement first?

   • A.Begin the prescribed 0.9% sodium chloride infusion
   • B.Administer subcutaneous long-acting insulin
   • C.Give sodium bicarbonate intravenously
   • D.Restrict fluids until the glucose decreases

   Rationale: The findings indicate diabetic ketoacidosis with significant volume depletion, so isotonic fluid replacement is the immediate priority. Regular insulin infusion is generally started after initial fluid resuscitation and evaluation of potassium; long-acting insulin alone is not adequate acute treatment. Bicarbonate is not routinely given at this pH, and fluid restriction worsens dehydration.

4. 4.A 29-year-old client at 30 weeks of pregnancy arrives at the labor unit with painless bright-red vaginal bleeding. The blood pressure is 112/70 mm Hg, pulse is 96/min, and fetal heart rate is 145/min. Which action should the nurse take?

   • A.Perform a vaginal examination to determine cervical dilation
   • B.Place the client on a monitor and notify the obstetric provider
   • C.Encourage ambulation to assess whether the bleeding continues
   • D.Begin oxytocin to stimulate uterine contractions

   Answer and rationale are in the full material.

5. 5.A 3-year-old child is seen in an urgent care clinic with a barking cough, hoarse voice, and inspiratory stridor at rest. Temperature is 38.0 C (100.4 F), respiratory rate is 34/min, and oxygen saturation is 93%. Which action is the priority?

   • A.Inspect the throat with a tongue blade
   • B.Keep the child calm and prepare to administer nebulized epinephrine
   • C.Obtain a throat culture before treatment
   • D.Encourage the child to lie flat for a complete examination

   Answer and rationale are in the full material.