ATI COMPREHENSIVE EXIT EXAM
WITH NGN NEWEST
ACTUAL EXAM QUESTIONS AND
CORRECT DETAILED
ANSWERS
4. A nurse in an outpatient mental health clinic is caring for a client
Vital Signs
3 months ago
Blood pressure 116/68 mmHg
Heart rate 82/min
Respiratory rate 16/min
Temperature 36.7 C (98.1 F) SaO2 97% on room air
Today:
Blood pressure 128/76 mmHg Heart rate 104/min Respiratory rate 22/min
Temperature 37.4 (99.4 F) SaO2 97% on room air
5 Nurses' Notes
,6
3 months ago
Client recently admitted with new diagnosis of schizophrenia. Received in-
patient treatment for 10 days and was discharged 1 week ago.: Select the 3
findings that require immediate follow up:
- Auditory hallucinations
- Speech
- Restlessness
When recognizing cues, the nurse should identify that the findings of
restlessness, auditory hallucinations, and pressured speech require immediate
follow up. These findings are indications of psychosis. The nurse should notify
the provider for addi- tional evaluation and treatment.
5. A nurse is caring for a client who is postoperative following coronary artery
bypass surgery (CABG)
Laboratory Results
0630
Sodium 145 mEq/L (136 to 145 mEq/L)
Potassium 3.2 mEq/L (3.5 to 5 mEq/L)
Chloride 116 mEq/L (98 to 106 mEq/L)
BUN 24 mg/dL (10 to 20 mg/dL)
Magnesium 1.5 mEq/L (1.3 to 2.1 mEq/L)
Total calcium 9 mg/dL (9 to 10.5 mg/dL)
,Phosphate 4.6 mg/dL (3 to 4.5 mg/dL)
Glucose 95 mg/dL (74 to 106 mg/dL)
WBC count 9,500/mm3 (5,000 to 10,000/mm3)
I&O
0700
4 hr input 400 mL
4 hr output: The client is at greatest risk for developing dysrhythmias, as
evidenced by electrolyte imbalance.
The nurse should analyze cues to determine the client is at greatest risk for
devel- oping dysrhythmias related to hypokalemia, as evidenced by the
laboratory report and the client's report of muscle cramping. Potassium and
magnesium depletion are common manifestations in clients who are
postoperative following CABG. Due to medication or hemodilation, it is
important for the nurse to closely monitor electrolytes.
A nurse is caring for a 5-year-old child
Physical Examination:
1510:
Upon visual inspection, throat is inflamed, tonsils appear pink, reddened and
epiglottis is edematous and cherry red in appearance. Skin appears pale.
Stridor noted upon inspiration with diminished bilateral lung sounds.
Nurse's Notes:
, 1500
Child accompanied to emergency department by caregiver. Caregiver states
child has a sore throat and reports the child has "pain on swallowing" and denies
cough.
Child is agitated and lean: Condition: Epiglottis
Actions: Initiate droplet precautions and request a prescription for IV antibiotics
Monitors: Breath sounds and temperature
The nurse should anticipate initiating droplet precautions and requesting a
prescrip- tion for IV antibiotics. The child is most likely experiencing epiglottis
because of the clinical manifestations of a high fever, inflammation and redness
of the throat, pale skin, stridor with inspiration, painful swallowing, no cough, is
sitting in tripod position, and drooling. The nurse should monitor the child's
temperature and breath sounds.
1. A nurse is caring for a client who is on the spinal cord injury (SCI) unit
Nurses' Notes
Day 3, 1700
Client admitted to SCI unit 3 days ago following C7 injury. Skin is cool, pale,
and dry to touch. Respirations easy and unlabored. Lung sounds diminished in
lower lobes. Abdomen soft and nondistended with active bowel sounds.
Client passed a small amount of hard formed stool this AM. Indwelling urinary
catheter draining clear yellow urine. Deep tendon reflexes (DTR) are biceps 1+,
triceps 1+, pa: The client is most likely experiencing manifestations of
pneumonia and autonomic dysreflexia.
The nurse should analyze cues from the client's manifestations and determine
that the client is most likely experiencing manifestations of pneumonia and
WITH NGN NEWEST
ACTUAL EXAM QUESTIONS AND
CORRECT DETAILED
ANSWERS
4. A nurse in an outpatient mental health clinic is caring for a client
Vital Signs
3 months ago
Blood pressure 116/68 mmHg
Heart rate 82/min
Respiratory rate 16/min
Temperature 36.7 C (98.1 F) SaO2 97% on room air
Today:
Blood pressure 128/76 mmHg Heart rate 104/min Respiratory rate 22/min
Temperature 37.4 (99.4 F) SaO2 97% on room air
5 Nurses' Notes
,6
3 months ago
Client recently admitted with new diagnosis of schizophrenia. Received in-
patient treatment for 10 days and was discharged 1 week ago.: Select the 3
findings that require immediate follow up:
- Auditory hallucinations
- Speech
- Restlessness
When recognizing cues, the nurse should identify that the findings of
restlessness, auditory hallucinations, and pressured speech require immediate
follow up. These findings are indications of psychosis. The nurse should notify
the provider for addi- tional evaluation and treatment.
5. A nurse is caring for a client who is postoperative following coronary artery
bypass surgery (CABG)
Laboratory Results
0630
Sodium 145 mEq/L (136 to 145 mEq/L)
Potassium 3.2 mEq/L (3.5 to 5 mEq/L)
Chloride 116 mEq/L (98 to 106 mEq/L)
BUN 24 mg/dL (10 to 20 mg/dL)
Magnesium 1.5 mEq/L (1.3 to 2.1 mEq/L)
Total calcium 9 mg/dL (9 to 10.5 mg/dL)
,Phosphate 4.6 mg/dL (3 to 4.5 mg/dL)
Glucose 95 mg/dL (74 to 106 mg/dL)
WBC count 9,500/mm3 (5,000 to 10,000/mm3)
I&O
0700
4 hr input 400 mL
4 hr output: The client is at greatest risk for developing dysrhythmias, as
evidenced by electrolyte imbalance.
The nurse should analyze cues to determine the client is at greatest risk for
devel- oping dysrhythmias related to hypokalemia, as evidenced by the
laboratory report and the client's report of muscle cramping. Potassium and
magnesium depletion are common manifestations in clients who are
postoperative following CABG. Due to medication or hemodilation, it is
important for the nurse to closely monitor electrolytes.
A nurse is caring for a 5-year-old child
Physical Examination:
1510:
Upon visual inspection, throat is inflamed, tonsils appear pink, reddened and
epiglottis is edematous and cherry red in appearance. Skin appears pale.
Stridor noted upon inspiration with diminished bilateral lung sounds.
Nurse's Notes:
, 1500
Child accompanied to emergency department by caregiver. Caregiver states
child has a sore throat and reports the child has "pain on swallowing" and denies
cough.
Child is agitated and lean: Condition: Epiglottis
Actions: Initiate droplet precautions and request a prescription for IV antibiotics
Monitors: Breath sounds and temperature
The nurse should anticipate initiating droplet precautions and requesting a
prescrip- tion for IV antibiotics. The child is most likely experiencing epiglottis
because of the clinical manifestations of a high fever, inflammation and redness
of the throat, pale skin, stridor with inspiration, painful swallowing, no cough, is
sitting in tripod position, and drooling. The nurse should monitor the child's
temperature and breath sounds.
1. A nurse is caring for a client who is on the spinal cord injury (SCI) unit
Nurses' Notes
Day 3, 1700
Client admitted to SCI unit 3 days ago following C7 injury. Skin is cool, pale,
and dry to touch. Respirations easy and unlabored. Lung sounds diminished in
lower lobes. Abdomen soft and nondistended with active bowel sounds.
Client passed a small amount of hard formed stool this AM. Indwelling urinary
catheter draining clear yellow urine. Deep tendon reflexes (DTR) are biceps 1+,
triceps 1+, pa: The client is most likely experiencing manifestations of
pneumonia and autonomic dysreflexia.
The nurse should analyze cues from the client's manifestations and determine
that the client is most likely experiencing manifestations of pneumonia and
