ATI RN Mental Health Online Practice 2023 WITH (NGN) LATEST|
QUESTIONS 100% CORRECT ANSWERS
AND RATIONALE GRADED A+
Next Gen Question:
A nurse is assessing an older adult client who is postoperative following a right knee arthroplasty.
History and Physical
Day 1 0800:
75-year-old client who has osteoarthritis of the knees. Reports increased pain to the right knee following their
daily walk of 3 miles.
History of type 2 diabetes mellitus, GERD, hyperlipidemia, and hypothyroidism.
No known allergies.
Nurses' Notes
Day 3 0800:
Client is postoperative day three from right knee arthroplasty. Currently with operative knee in the continuous
passive motion (CPM) machine but attempting to take knee out of device. States, "I've had enough of this mess.
I'm going home." Client is disoriented to time and place, oriented to self. Refuses to answer simple questions,
rambles incoherently when spoken to. Will not follow simple commands. Client's family is at bedside and reports
the client began displaying behavior changes the prior evening. States that client was awake most of the night and
was restless when they did fall asleep, appeared to be having nightmares. Attempted to get out of bed without
assistance during the early morning hours.
Surgical dressing to right knee dry and intact. No sign of redness or edema around the dressing. Client refuses to
answer questions about surgical pain or respond to prompts using pain scales. According to client's family, client
has not received pain medication since before physical therapy yesterday afternoon and has not reported pain.
Requested client's family to please remain at the bedside and to call for any needs or if the client attempts to get
out of bed without assistance.
Placed call to provider to report findings. Awaiting call-back.
Graphic Record
Day 3 0800:
Heart rate 115/min
Respiratory rate 20/min
Blood pressure 90/48 mm Hg
Temperature 38.6° C (101.5° F)
Oxygen saturation 96% on room air
Weight 63.5 kg (140 lb)
Intake and Output (I&O)
I = 750 mL
O = 2,500 mL
Provider Prescriptions
Day 1:
Enoxaparin 30 mg subcutaneously twice daily
Levothyroxine 75 mcg PO once daily
Omeprazole 20 mg PO once daily
Pravastatin 40 mg PO once daily at bedtime
Morphine 2 to 4 mg intermittent IV bolus every 4 hr PRN pain
Hydrocodone 5 mg PO every 6 hr PRN pain
Acetaminophen 325 mg PO every 6 hr PRN pain or temperature greater than 38.3° C (101° F)
Diagnostic Results
,Day 3 0800:
Capillary blood glucose 92 mg/dL (82 to 115 mg/dL)
1. Which of the following findings should the nurse report to the provider immediately? Select the 5
findings that require immediate follow-up.
a. Cognitive awareness is correct. The nurse should evaluate the client for previous and current
cognitive status to provide a safe environment. The client's sudden change in cognitive
awareness should be reported to the provider because delirium is a medical emergency.
b. Blood pressure is correct. The client's blood pressure is above the expected reference range and
should be reported to the provider. Clients who are experiencing delirium might experience an
elevated heart rate and blood pressure.
c. Sleep/wake cycle is correct. The client's lack of sleep and restlessness during the night are
indications that the client might be experiencing delirium and should be reported to the
provider. Confusion and disorientation are often worse at night.
d. Temperature is correct. A temperature of 38.6° C (101.5° F) on day 3 following right knee
arthroplasty is above the expected reference range and should be reported to the provider.
Next Gen Question:
A nurse is assessing an older adult client who is postoperative following a right knee arthroplasty.
History and Physical
Day 1 0800:
75-year-old client who has osteoarthritis of the knees. Reports increased pain to the right knee following their
daily walk of 3 miles.
History of type 2 diabetes mellitus, GERD, hyperlipidemia, and hypothyroidism.
No known allergies.
Nurses' Notes
Day 3 0800:
Client is postoperative day three from right knee arthroplasty. Currently with operative knee in the continuous
passive motion (CPM) machine but attempting to take knee out of device. States, "I've had enough of this mess.
I'm going home." Client is disoriented to time and place, oriented to self. Refuses to answer simple questions,
rambles incoherently when spoken to. Will not follow simple commands. Client's family is at bedside and reports
the client began displaying behavior changes the prior evening. States that client was awake most of the night and
was restless when they did fall asleep, appeared to be having nightmares. Attempted to get out of bed without
assistance during the early morning hours.
Surgical dressing to right knee dry and intact. No sign of redness or edema around the dressing. Client refuses to
answer questions about surgical pain or respond to prompts using pain scales. According to client's family, client
has not received pain medication since before physical therapy yesterday afternoon and has not reported pain.
Requested client's family to please remain at the bedside and to call for any needs or if the client attempts to get
out of bed without assistance.
Placed call to provider to report findings. Awaiting call-back.
Graphic Record
Day 3 0800:
Heart rate 115/min
Respiratory rate 20/min
Blood pressure 90/48 mm Hg
Temperature 38.6° C (101.5° F)
Oxygen saturation 96% on room air
Weight 63.5 kg (140 lb)
Intake and Output (I&O)
I = 750 mL
O = 2,500 mL
,Provider Prescriptions
Day 1:
Enoxaparin 30 mg subcutaneously twice daily
Levothyroxine 75 mcg PO once daily
Omeprazole 20 mg PO once daily
Pravastatin 40 mg PO once daily at bedtime
Morphine 2 to 4 mg intermittent IV bolus every 4 hr PRN pain
Hydrocodone 5 mg PO every 6 hr PRN pain
Acetaminophen 325 mg PO every 6 hr PRN pain or temperature greater than 38.3° C (101° F)
Diagnostic Results
Day 3 0800:
Capillary blood glucose 92 mg/dL (82 to 115 mg/dL)
2. For each potential provider's prescription, click to specify if the potential prescription is anticipated,
nonessential, or contraindicated for the client.
a. Apply restraints is contraindicated. Physical restraints could increase the client's manifestations
of delirium and should be avoided.
b. Urinalysis with culture and sensitivity is anticipated. Initial assessment of a client experiencing
delirium should include a review of laboratory results, including urinalysis, to rule out infection.
c. Insert indwelling urinary catheter is contraindicated. Urinary catheters should be inserted only
when necessary, such as for a client who is experiencing urinary retention or blockage.
d. Melatonin is anticipated. Melatonin is an over-the-counter supplement used for insomnia and
has been found to be beneficial in the prevention and treatment of delirium.
e. MRI of the head is nonessential. MRIs are used to obtain an image of the soft tissue of the brain
and are useful in identifying atrophied areas of the brain, such as those found in clients who have
Alzheimer's disease.
f. IV fluids is anticipated. The client's oral intake is significantly less than their output and should
be supplemented with IV fluids to prevent dehydration.
, Next Gen Question:
A nurse is caring for a client who is experiencing delirium.
History and Physical
Day 1 0800:
75-year-old client who has osteoarthritis of the knees. Reports increased pain to the right knee following their
daily walk of 3 miles.
History of type 2 diabetes mellitus, GERD, hyperlipidemia, and hypothyroidism.
No known allergies.
Nurses' Notes
Day 3 0800:
Client is postoperative day three from right knee arthroplasty. Currently with operative knee in the continuous
passive motion (CPM) machine but attempting to take knee out of device. States, "I've had enough of this mess.
I'm going home." Client is disoriented to time and place, oriented to self. Refuses to answer simple questions,
rambles incoherently when spoken to. Will not follow simple commands. Client's family is at bedside and reports
the client began displaying behavior changes the prior evening. States that client was awake most of the night and
was restless when they did fall asleep, appeared to be having nightmares. Attempted to get out of bed without
assistance during the early morning hours.
Surgical dressing to right knee dry and intact. No sign of redness or edema around the dressing. Client refuses to
answer questions about surgical pain or respond to prompts using pain scales. According to client's family, client
has not received pain medication since before physical therapy yesterday afternoon and has not reported pain.
Requested client's family to please remain at the bedside and to call for any needs or if the client attempts to get
out of bed without assistance.
Placed call to provider to report findings. Awaiting call-back.
Day 3 0900:
Return call from client's provider, update given, prescriptions received.
Upon entering client's room, find client attempting to get out of bed. Client's family is trying to stop them. Client is
agitated and disoriented to place, attempting to pull out IV device, becomes incontinent of urine in the bed.
Client's family states, "That has never happened before."
Reassurance offered to client and their family.
Assistive personnel called to help with bathing client and changing linens.
Client calmer following hygiene and comfort measures. States having knee pain of 5 on a scale of 0 to 10.
Requested client's family member to please remain at the bedside and to call for any needs or if the client
attempts to get out of bed without assistance.
Day 3 0930:
Administered hydrocodone for report of knee pain.
Client resting quietly at this time. Family members at bedside.
Graphic Record
Day 3 0800:
Heart rate 115/min
Respiratory rate 20/min
Blood pressure 90/48 mm Hg
Temperature 38.6° C (101.5° F)
QUESTIONS 100% CORRECT ANSWERS
AND RATIONALE GRADED A+
Next Gen Question:
A nurse is assessing an older adult client who is postoperative following a right knee arthroplasty.
History and Physical
Day 1 0800:
75-year-old client who has osteoarthritis of the knees. Reports increased pain to the right knee following their
daily walk of 3 miles.
History of type 2 diabetes mellitus, GERD, hyperlipidemia, and hypothyroidism.
No known allergies.
Nurses' Notes
Day 3 0800:
Client is postoperative day three from right knee arthroplasty. Currently with operative knee in the continuous
passive motion (CPM) machine but attempting to take knee out of device. States, "I've had enough of this mess.
I'm going home." Client is disoriented to time and place, oriented to self. Refuses to answer simple questions,
rambles incoherently when spoken to. Will not follow simple commands. Client's family is at bedside and reports
the client began displaying behavior changes the prior evening. States that client was awake most of the night and
was restless when they did fall asleep, appeared to be having nightmares. Attempted to get out of bed without
assistance during the early morning hours.
Surgical dressing to right knee dry and intact. No sign of redness or edema around the dressing. Client refuses to
answer questions about surgical pain or respond to prompts using pain scales. According to client's family, client
has not received pain medication since before physical therapy yesterday afternoon and has not reported pain.
Requested client's family to please remain at the bedside and to call for any needs or if the client attempts to get
out of bed without assistance.
Placed call to provider to report findings. Awaiting call-back.
Graphic Record
Day 3 0800:
Heart rate 115/min
Respiratory rate 20/min
Blood pressure 90/48 mm Hg
Temperature 38.6° C (101.5° F)
Oxygen saturation 96% on room air
Weight 63.5 kg (140 lb)
Intake and Output (I&O)
I = 750 mL
O = 2,500 mL
Provider Prescriptions
Day 1:
Enoxaparin 30 mg subcutaneously twice daily
Levothyroxine 75 mcg PO once daily
Omeprazole 20 mg PO once daily
Pravastatin 40 mg PO once daily at bedtime
Morphine 2 to 4 mg intermittent IV bolus every 4 hr PRN pain
Hydrocodone 5 mg PO every 6 hr PRN pain
Acetaminophen 325 mg PO every 6 hr PRN pain or temperature greater than 38.3° C (101° F)
Diagnostic Results
,Day 3 0800:
Capillary blood glucose 92 mg/dL (82 to 115 mg/dL)
1. Which of the following findings should the nurse report to the provider immediately? Select the 5
findings that require immediate follow-up.
a. Cognitive awareness is correct. The nurse should evaluate the client for previous and current
cognitive status to provide a safe environment. The client's sudden change in cognitive
awareness should be reported to the provider because delirium is a medical emergency.
b. Blood pressure is correct. The client's blood pressure is above the expected reference range and
should be reported to the provider. Clients who are experiencing delirium might experience an
elevated heart rate and blood pressure.
c. Sleep/wake cycle is correct. The client's lack of sleep and restlessness during the night are
indications that the client might be experiencing delirium and should be reported to the
provider. Confusion and disorientation are often worse at night.
d. Temperature is correct. A temperature of 38.6° C (101.5° F) on day 3 following right knee
arthroplasty is above the expected reference range and should be reported to the provider.
Next Gen Question:
A nurse is assessing an older adult client who is postoperative following a right knee arthroplasty.
History and Physical
Day 1 0800:
75-year-old client who has osteoarthritis of the knees. Reports increased pain to the right knee following their
daily walk of 3 miles.
History of type 2 diabetes mellitus, GERD, hyperlipidemia, and hypothyroidism.
No known allergies.
Nurses' Notes
Day 3 0800:
Client is postoperative day three from right knee arthroplasty. Currently with operative knee in the continuous
passive motion (CPM) machine but attempting to take knee out of device. States, "I've had enough of this mess.
I'm going home." Client is disoriented to time and place, oriented to self. Refuses to answer simple questions,
rambles incoherently when spoken to. Will not follow simple commands. Client's family is at bedside and reports
the client began displaying behavior changes the prior evening. States that client was awake most of the night and
was restless when they did fall asleep, appeared to be having nightmares. Attempted to get out of bed without
assistance during the early morning hours.
Surgical dressing to right knee dry and intact. No sign of redness or edema around the dressing. Client refuses to
answer questions about surgical pain or respond to prompts using pain scales. According to client's family, client
has not received pain medication since before physical therapy yesterday afternoon and has not reported pain.
Requested client's family to please remain at the bedside and to call for any needs or if the client attempts to get
out of bed without assistance.
Placed call to provider to report findings. Awaiting call-back.
Graphic Record
Day 3 0800:
Heart rate 115/min
Respiratory rate 20/min
Blood pressure 90/48 mm Hg
Temperature 38.6° C (101.5° F)
Oxygen saturation 96% on room air
Weight 63.5 kg (140 lb)
Intake and Output (I&O)
I = 750 mL
O = 2,500 mL
,Provider Prescriptions
Day 1:
Enoxaparin 30 mg subcutaneously twice daily
Levothyroxine 75 mcg PO once daily
Omeprazole 20 mg PO once daily
Pravastatin 40 mg PO once daily at bedtime
Morphine 2 to 4 mg intermittent IV bolus every 4 hr PRN pain
Hydrocodone 5 mg PO every 6 hr PRN pain
Acetaminophen 325 mg PO every 6 hr PRN pain or temperature greater than 38.3° C (101° F)
Diagnostic Results
Day 3 0800:
Capillary blood glucose 92 mg/dL (82 to 115 mg/dL)
2. For each potential provider's prescription, click to specify if the potential prescription is anticipated,
nonessential, or contraindicated for the client.
a. Apply restraints is contraindicated. Physical restraints could increase the client's manifestations
of delirium and should be avoided.
b. Urinalysis with culture and sensitivity is anticipated. Initial assessment of a client experiencing
delirium should include a review of laboratory results, including urinalysis, to rule out infection.
c. Insert indwelling urinary catheter is contraindicated. Urinary catheters should be inserted only
when necessary, such as for a client who is experiencing urinary retention or blockage.
d. Melatonin is anticipated. Melatonin is an over-the-counter supplement used for insomnia and
has been found to be beneficial in the prevention and treatment of delirium.
e. MRI of the head is nonessential. MRIs are used to obtain an image of the soft tissue of the brain
and are useful in identifying atrophied areas of the brain, such as those found in clients who have
Alzheimer's disease.
f. IV fluids is anticipated. The client's oral intake is significantly less than their output and should
be supplemented with IV fluids to prevent dehydration.
, Next Gen Question:
A nurse is caring for a client who is experiencing delirium.
History and Physical
Day 1 0800:
75-year-old client who has osteoarthritis of the knees. Reports increased pain to the right knee following their
daily walk of 3 miles.
History of type 2 diabetes mellitus, GERD, hyperlipidemia, and hypothyroidism.
No known allergies.
Nurses' Notes
Day 3 0800:
Client is postoperative day three from right knee arthroplasty. Currently with operative knee in the continuous
passive motion (CPM) machine but attempting to take knee out of device. States, "I've had enough of this mess.
I'm going home." Client is disoriented to time and place, oriented to self. Refuses to answer simple questions,
rambles incoherently when spoken to. Will not follow simple commands. Client's family is at bedside and reports
the client began displaying behavior changes the prior evening. States that client was awake most of the night and
was restless when they did fall asleep, appeared to be having nightmares. Attempted to get out of bed without
assistance during the early morning hours.
Surgical dressing to right knee dry and intact. No sign of redness or edema around the dressing. Client refuses to
answer questions about surgical pain or respond to prompts using pain scales. According to client's family, client
has not received pain medication since before physical therapy yesterday afternoon and has not reported pain.
Requested client's family to please remain at the bedside and to call for any needs or if the client attempts to get
out of bed without assistance.
Placed call to provider to report findings. Awaiting call-back.
Day 3 0900:
Return call from client's provider, update given, prescriptions received.
Upon entering client's room, find client attempting to get out of bed. Client's family is trying to stop them. Client is
agitated and disoriented to place, attempting to pull out IV device, becomes incontinent of urine in the bed.
Client's family states, "That has never happened before."
Reassurance offered to client and their family.
Assistive personnel called to help with bathing client and changing linens.
Client calmer following hygiene and comfort measures. States having knee pain of 5 on a scale of 0 to 10.
Requested client's family member to please remain at the bedside and to call for any needs or if the client
attempts to get out of bed without assistance.
Day 3 0930:
Administered hydrocodone for report of knee pain.
Client resting quietly at this time. Family members at bedside.
Graphic Record
Day 3 0800:
Heart rate 115/min
Respiratory rate 20/min
Blood pressure 90/48 mm Hg
Temperature 38.6° C (101.5° F)
