ATI LEVEL 2 PROCTORED UPDATED EXAMS
COMPREHENSIVE QUESTIONS AND ANSWERS SURE
A+
✔✔A nurse is caring for a client who has respiratory depression following opioid
administration to control cancer-related pain. The client's ABG results are pH 7.28,
PaCO2 49 mm Hg, and HCO3- 24 mEq/L. Based on these findings, the nurse should
identify that the client has which of the following acid-base imbalances?
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis - ✔✔Respiratory acidosis
With this acid-base imbalance, the client's pH is below the expected reference range,
the PaCO2 is above the expected reference range, and the HCO3- is within or possibly
above the expected reference range. Common causes of respiratory acidosis are
respiratory depression due to anesthesia or opioid administration, airway obstruction,
and inadequate chest expansion.
,✔✔A nurse has arrived at the site of an accident where a client has sustained a
traumatic amputation of the big toe. Identify the sequence of steps the nurse should
take to treat the musculoskeletal trauma. (Move the steps into the box on the right,
placing them in the order of performance. Use all the steps.) - ✔✔The nurse should first
call 911 and examine the amputation site. Next, the nurse should apply direct pressure
with layers of dry cloth to slow or stop the bleeding. Then, the nurse should elevate the
affected extremity above the client's heart to slow the bleeding. Next, the nurse should
find the toe and wrap it in sterile gauze or a clean cloth to decrease contamination for
possible surgical reattachment. Finally, the nurse should place the wrapped toe in a bag
and place the bag in 1 part ice and 3 parts water to maintain tissue integrity for possible
reattachment.
✔✔A nurse is assessing a client who has been taking antacids frequently for
gastrointestinal distress. The assessment findings include drowsiness, muscle
weakness, bradycardia, and hypotension. Which of the following electrolyte imbalances
should the nurse suspect?
Hypophosphatemia
Hypochloremia
Hypermagnesemia
Hypernatremia - ✔✔Hypermagnesemia
The nurse should identify that frequent ingestion of antacids and laxatives that contain
magnesium can cause hypermagnesemia. Manifestations include hypotension,
bradycardia, absent deep tendon reflexes, weak skeletal muscle contractions, ECG
changes, lethargy, and drowsiness that can progress to coma.
✔✔A nurse in a provider's office is completing a preoperative screening for a client who
is scheduled for a knee arthroplasty later that week. Which of the following findings
requires the nurse's intervention? (Click on the exhibit button for additional information
about the client. There are three tabs that contain separate categories of data.) -
✔✔Coagulation time
The nurse should report the client's coagulation time, or INR, to the provider
immediately because it is above the expected reference range, which predisposes the
client to intraoperative and/or postoperative hemorrhage. The nurse should expect the
provider to postpone the joint arthroplasty until the client's clotting time is within the
expected reference range.
✔✔A nurse in an emergency department is caring for a client whose ABG results are
pH 7.31, PaCO2 50 mm Hg, and HCO3- 25 mEq/L after experiencing an airway
obstruction. Which of the following interventions is the nurse's priority for this client?
, Apply oxygen therapy to the client.
Administer an anti-inflammatory medication.
Check the client's nail beds.
Initiate IV fluid therapy. - ✔✔Apply oxygen therapy to the client.
The first action the nurse should take when using the airway, breathing, circulation
approach to caring for a client who has respiratory acidosis is to improve the client's
oxygenation. When the client's airway is patent, oxygenation and ventilation are the
priorities.
✔✔A nurse is caring for a client who has a fear of open spaces. Which of the following
clinical names for this fear should the nurse document in the client's medical record?
Pyrophobia
Agoraphobia
Monophobia
Astraphobia - ✔✔Agoraphobia
The nurse should document that the client is experiencing agoraphobia in the client's
medical record. Agoraphobia is the fear of being outside and can be debilitating and
limit a client's ability to function.
✔✔A nurse is teaching a client ways to prevent osteoporotic fractures due to
osteoporosis. Which of the following information should the nurse include in the
teaching?
"Maintain bone health by eating fruits, vegetables, and protein."
"Tamsulosin can slow the progression of bone deterioration."
"Walk 20 minutes two times a week to manage osteoporosis."
"Start to increase vitamin C and magnesium in your diet." - ✔✔"Maintain bone health by
eating fruits, vegetables, and protein."
The nurse should instruct the client that the best way to maintain bone health and bone
remodeling is by eating fruits, vegetables, and protein.
COMPREHENSIVE QUESTIONS AND ANSWERS SURE
A+
✔✔A nurse is caring for a client who has respiratory depression following opioid
administration to control cancer-related pain. The client's ABG results are pH 7.28,
PaCO2 49 mm Hg, and HCO3- 24 mEq/L. Based on these findings, the nurse should
identify that the client has which of the following acid-base imbalances?
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis - ✔✔Respiratory acidosis
With this acid-base imbalance, the client's pH is below the expected reference range,
the PaCO2 is above the expected reference range, and the HCO3- is within or possibly
above the expected reference range. Common causes of respiratory acidosis are
respiratory depression due to anesthesia or opioid administration, airway obstruction,
and inadequate chest expansion.
,✔✔A nurse has arrived at the site of an accident where a client has sustained a
traumatic amputation of the big toe. Identify the sequence of steps the nurse should
take to treat the musculoskeletal trauma. (Move the steps into the box on the right,
placing them in the order of performance. Use all the steps.) - ✔✔The nurse should first
call 911 and examine the amputation site. Next, the nurse should apply direct pressure
with layers of dry cloth to slow or stop the bleeding. Then, the nurse should elevate the
affected extremity above the client's heart to slow the bleeding. Next, the nurse should
find the toe and wrap it in sterile gauze or a clean cloth to decrease contamination for
possible surgical reattachment. Finally, the nurse should place the wrapped toe in a bag
and place the bag in 1 part ice and 3 parts water to maintain tissue integrity for possible
reattachment.
✔✔A nurse is assessing a client who has been taking antacids frequently for
gastrointestinal distress. The assessment findings include drowsiness, muscle
weakness, bradycardia, and hypotension. Which of the following electrolyte imbalances
should the nurse suspect?
Hypophosphatemia
Hypochloremia
Hypermagnesemia
Hypernatremia - ✔✔Hypermagnesemia
The nurse should identify that frequent ingestion of antacids and laxatives that contain
magnesium can cause hypermagnesemia. Manifestations include hypotension,
bradycardia, absent deep tendon reflexes, weak skeletal muscle contractions, ECG
changes, lethargy, and drowsiness that can progress to coma.
✔✔A nurse in a provider's office is completing a preoperative screening for a client who
is scheduled for a knee arthroplasty later that week. Which of the following findings
requires the nurse's intervention? (Click on the exhibit button for additional information
about the client. There are three tabs that contain separate categories of data.) -
✔✔Coagulation time
The nurse should report the client's coagulation time, or INR, to the provider
immediately because it is above the expected reference range, which predisposes the
client to intraoperative and/or postoperative hemorrhage. The nurse should expect the
provider to postpone the joint arthroplasty until the client's clotting time is within the
expected reference range.
✔✔A nurse in an emergency department is caring for a client whose ABG results are
pH 7.31, PaCO2 50 mm Hg, and HCO3- 25 mEq/L after experiencing an airway
obstruction. Which of the following interventions is the nurse's priority for this client?
, Apply oxygen therapy to the client.
Administer an anti-inflammatory medication.
Check the client's nail beds.
Initiate IV fluid therapy. - ✔✔Apply oxygen therapy to the client.
The first action the nurse should take when using the airway, breathing, circulation
approach to caring for a client who has respiratory acidosis is to improve the client's
oxygenation. When the client's airway is patent, oxygenation and ventilation are the
priorities.
✔✔A nurse is caring for a client who has a fear of open spaces. Which of the following
clinical names for this fear should the nurse document in the client's medical record?
Pyrophobia
Agoraphobia
Monophobia
Astraphobia - ✔✔Agoraphobia
The nurse should document that the client is experiencing agoraphobia in the client's
medical record. Agoraphobia is the fear of being outside and can be debilitating and
limit a client's ability to function.
✔✔A nurse is teaching a client ways to prevent osteoporotic fractures due to
osteoporosis. Which of the following information should the nurse include in the
teaching?
"Maintain bone health by eating fruits, vegetables, and protein."
"Tamsulosin can slow the progression of bone deterioration."
"Walk 20 minutes two times a week to manage osteoporosis."
"Start to increase vitamin C and magnesium in your diet." - ✔✔"Maintain bone health by
eating fruits, vegetables, and protein."
The nurse should instruct the client that the best way to maintain bone health and bone
remodeling is by eating fruits, vegetables, and protein.
