ATI PN COMPREHENSIVE EXIT EXAM
180 NGN QUESTIONS AND VERIFIED ANSWERS & RATIONALES
WELL GRADED, BEST ATI COMPREHENSIVE
1. A nurse is collecting data on a newborn who is 3 days old.Exhibit
1
History and Physical
Newborn was delivered at 37 weeks gestation via cesarean section for fetal
distress.Apgar scores 8 at 1 min and 9 at 5 min.Birthweight 2,892 g (6 lb 6 oz)The clien
who gave birth plans to breastfeed.
Exhibit 2
Flow Sheet
Day 2 of Life
0900:
Temperature 36.7° C (98° F)Heart rate 140/minRespiratory rate 48/minWeight2,718 g
, (6 lb), 6% weight lossDay 3 of Life
0800:
Temperature 36.4° C (97.5° F)Heart rate 140/minRespiratory rate 48/minWeight2,545 g
(5 lb 9 oz), 12% weight loss
Exhibit 3
Nurses' Notes
Day 3 of Life
0800:
Skin color consistent with newborn's genetic background. Respirations easyand
unlabored. Abdomen soft with active bowel sounds. Mild tremors noted when awake.
Anterior fontanel level and soft. Large ecchymotic caput suc- cedaneum noted on
posterior scalp. Small amount of bloody mucus dischargenoted from vag:
Click to highlight the findings that require follow-up. To deselect afinding, click on the finding
again.
Temperature 36.4° C (97.5° F)
Weight 2,545 g (5 lb 9 oz) 12% weight lossMild
tremors noted when awake.
Breastfeeding every 3 to 5 hr for 5 to 10 min.
,Birth parent reports nipple discomfort throughout the feeding.
When recognizing cues, the nurse should identify that a temperature of 36.4° C (97.5° F) is
below the expected reference range. Hypothermia can lead to the occur-rence of hypoglycemia
and respiratory distress. The newborn breastfeeding for shortintervals, nipple discomfort, and a
weight loss of greater than 10% of birth weight
,can indicate inadequate transfer of breastmilk, which can result in hypoglycemia.The
presence of mild tremors can be a manifestation of hypoglycemia.
2. A nurse is assisting with the care of a client who was admitted to the
emergency department (ED).
Exhibit 1
Admission Assessment
Day 1
1930:
Client admitted to the ED by police after report of violent behavior in public. Client
smashed a glass window with their hands. Client is stating, "I am Je- sus." Client is
attempting to hit staff. Client placed in restraints. Neuro: Clientis alert and oriented x
0. Client is swinging their arms and shouting. Client
is unable to answer questions and their speech is rapid and unorganized. Heart rate is
108/min, regularIntegumentary: Laceration noted to the client's left hand (2 cm x 2.5
cm). Laceration noted to the left forearm (4 cm x 6 cm). Profuse bleeding noted.
Multiple small lacerations noted to face, left arm, andright arm. Allergies: Unable to
assess
Exhibit 2
,Vital Signs
Day 1
1930:
Temperature 36.7° C (98.0° F)Pulse 108/minRespiratory rate 24/minBP 150/92mm
Hg1945:
P: For each potential assessment finding, click to specify if the finding is consistentwith
schizophrenia or bipolar 1 disorder. Each finding may support more than 1 disease process.
When analyzing cues, the nurse should distinguish between positive and negative
manifestations of schizophrenia and bipolar 1 disorder. The client is displaying posi- tive
manifestations of schizophrenia, when compared to the assessment findings ofa client who has
bipolar 1 disorder.
3. A nurse is caring for a client in an inpatient mental health facility.Exhibit
1
Medical HistoryClient is 44 years old, well-nourished, presenting with recur- rence of
labile behavior involving self-mutilation, recent arrest for reckless dri-ving, stealing mone
from work for gambling debts, depressive episodes, andbinge eating.Provider's skin
assessment reveals multiple superficial self-in- flicted lacerations to right arm.
Client plays golf three mornings per week.
, Employed as salesperson at a car dealership for 8 years.Exhibit
2
Nurses' Notes
Day 1
1500:
Client is talkative, well-groomed.
Expresses anxiety when left alone and states they would prefer a roommate.The client
tends to be the center of attention in the dayroom.
1600:
Client assigned a roommate.Day 2
1300:
Pacing for last hour and mumbling to self. Argued with staff earlier about goingto lunch in
the cafeteria.
Glaring at staff members with fists clenche:
Select the 2 findings from the client'smedical record that are manifestations of borderline
personality disorder.
Behavior toward roommate
Skin assessment
,When recognizing cues, the nurse should identify that the client's skin assessmentand behavior
toward roommate are indications of borderline personality disorder.
Clients who have borderline personality disorder display unstable relationships, labile moods,
and impulsivity, such as excessive spending, binging, substance abuse, and reckless driving. Th
also have recurrent episodes of self-harm and might engage in suicidal actions. They have
difficulty controlling their anger and might have paranoid ideations. They have chronic feelings
of emptiness and do notlike to be alone.
4. A nurse is assisting with the care of a client who is 1 day postoperativefollowing
a total thyroidectomy.
Exhibit 1
Laboratory ResultsDay 2, 0700:
Sodium 143 mEq/L (136 to 145 mEq/L)Potassium 3.5 mEq/L (3.5 to 5
mEq/L)Chloride 104 mEq/L (98 to 106 mEq/L)BUN 15 mg/dL (10 to 20
mg/dL)Magnesium 1.5 mEq/L (1.3 to 2.1 mEq/L)Total calcium 8 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)
Exhibit 2
Nurses' Notes
Day 2, 0700:
,Client alert and oriented x 3. Respirations even and unlabored with no adven-titious
sounds. Bowel sounds active in all four quadrants. Surgical dressing dry, slight edema
at incision site noted. Client rates dull pain in neck at 2 on a0 to 10 scale. Declines pain
medication.1100:
Client alert and oriented x 3. Respirations even and unlabored with no ad- ventitious
sounds. Bowel sounds active in all four quadrants.: Complete thefollowing sentence by
using the lists of options.
The client is at highest risk for developing
hypocalcemia
as evidenced by the
report of numbness around lips
The nurse should recognize cues and determine that the client is at highest risk for
developing hypocalcemia as evidenced by the client's report of muscle spasms,numbness
around lips, and decreased calcium level. Hypocalcemia is more likely tooccur in clients who
have experienced a thyroidectomy, due to accidental damageto the parathyroid. Numbness
around the lips is a clinical manifestation specific to hypocalcemia. Hypocalcemia presents as
muscle spasms and can lead to cardiacdysrhythmias. Hypocalcemia is the highest priority, as it
requires immediate treat- ment with calcium gluconate to avoid dysrhythmias and other
,complications.
5. A nurse is assisting with the care of a client who has schizophrenia in aninpatient
facility.
Exhibit 1
Medication Administration Record
Day 1
0630:
Clozapine 100 mg PO dailyAripiprazole 5 mg PO dailyMultivitamin PO dailyExhibit 2
Laboratory Results
Day 1
0630:
Sodium 125 mEq/L (136 to 145 mEq/L) Potassium 3.5 mEq/L (3.5 to 5 mEq/L)
Chloride 90 mEq/L (98 to 106 mEq/L) BUN 8 mg/dL (10 to 20 mg/dL) Magne-
sium 1.2 mEq/L (1.3 to 2.1 mEq/L) Total calcium 10 mg/dL (9 to 10.5 mg/dL)
Phosphate 4 mg/dL (3 to 4.5 mg/dL) Glucose 70 mg/dL (74 to 106 mg/dL)
Exhibit 3
Vital Signs
Day 1
, 0630:
Temperature 37.6° C (99.6° F)Heart rate 102/minRespiratory rate 24/minBlood
pressure 140/90 mm HgOxygen saturation 98% on room air
1230:
Temperature 37.6° C (98° F)Heart rate 98/minRespiratory rate 20/minBlood
pressure 142/92 mm HgOxygen saturation 100% on room air
1730:
Temperature 37.1° C (98.8° F)Heart rate 104/minRespiratory rate 24: Click to highlight
the findings that require immediate follow-up. To deselect a finding, click onthe finding again.
When analyzing cues, the nurse should identify that the client is taking a sec-
ond-generation antipsychotic medication, which can lead to manifestations of tardive dyskinesia,
including involuntary tongue movement and foot tremors. Frequent uri- nation and
incontinence are adverse effects of aripiprazole and should be reported to the provider. An
increase in agitation is a safety risk for the client, staff, and others on the unit and requires
immediate de-escalation.
6. A nurse is assisting with the care of a client who has a new diagnosis ofanorexia
nervosa.
Exhibit 1 Laboratory
