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ATI NURSE LOGISTIC KNOWLEDGE AND CLINICAL
JUDGEMENET ADVANCED EXAM 2025 QUESTIONS
AND CORRECT ANSWERS GRADE A
A nurse is caring for a client who has terminal pancreatic cancer. The client is competent and has requested no resuscitative measures be taken in the event of respiratory or cardiac arrest. Which of the following is necessary to legally change the client's code status to do-not-resuscitate? A. A written prescription from the provider B. Signed documentation from the client C. Family support of the decision D. Admission to hospice for palliative care A. A written prescription from the provider Rationale: A. In this item, you need specific knowledge of legal issues regarding a DNR code status. Based on your knowledge of this concept, you can select the option that describes requirements to legally change the code status of a client to a DNR. This item requires foundational thinking because you have to recall legalities associated with initiating a DNR. A DNR is typically instituted at the request of a client or family member and should be a written order instead of a verbal prescription. Until a DNR prescription exists, every attempt to revive the client should be made in the event of respiratory or cardiac arrest. A
written prescription from the provider is necessary to legally change the client's code status to a DNR. B. In this item, you need specific knowledge of legal issues regarding a DNR code status. Based on your knowledge of this concept, you can select the option that describes requirements to legally change the code status of a client to a DNR. This item requires foundational thinking because you have to recall legalities associated with initiating a DNR. The client, or the client's health care proxy if the client is not competent, should be notified by the provider before writing a prescription for a DNR. While the client and family should be in agreement, signed documentation is not a legal requirement to change the client's code status to a DNR. C. In this item, you need specific knowledge of legal issues regarding a DNR code status. Based on your knowledge of this concept, you can select the option that describes requirements to legally change the code status of a client to a DNR. This item requires foundational thinking because you have to recall legalities associated with initiating a DNR. Because the client is competent to make decisions, his requests should be given the highest priority; therefore, family support of the decision is not needed. If the client was not competent, the client's healthcare proxy or advance directives should guide the care of the client. D. In this item, you need specific knowledge of legal issues regarding a DNR code status. Based on your knowledge of this concept, you can select the option that describes requirements to legally change the code status of a client to a DNR. This item
ear drops. This is not an appropriate action by the nurse when administering ear drops. The toddler should be positioned on the unaffected side, instead of the affected side, for several minutes after instilling the ear drops to prevent the drops from flowing out of the canal. B. This item requires knowledge of appropriate techniques for administering ear drops. Based on your understanding of this concept, you can select the appropriate nursing action. This item requires foundational thinking because you have to recall knowledge of a specific nursing skill to appropriately administer ear drops. This is an appropriate action by the nurse when administering ear drops. Ear drops are topically administered medications, which are slowly absorbed through the skin and primarily provide local results. Because of the anatomy of internal ear structures, it is important to remember that the ear is sensitive to extremes in temperature. Ear drops should be warmed to room temperature prior to instillation to reduce the risk of painful stimuli. C. This item requires knowledge of appropriate techniques for administering ear drops. Based on your understanding of this concept, you can select the appropriate nursing action. This item requires foundational thinking because you have to recall knowledge of a specific nursing skill to appropriately administer ear drops. This is not an appropriate action by the nurse when administering ear drops for a toddler. To straighten the auditory canal, the pinna of a client under the age of 3 years should be pulled downward and back, instead of upward and back.
D. This item requires knowledge of appropriate techniques for administering ear drops. Based on your understanding of this concept, you can select the appropriate nursing action. This item requires foundational thinking because you have to recall knowledge of a specific nursing skill to appropriately administer ear drops. This is not an appropriate action by the nurse when administering ear drops. The area anterior to the ear, instead of posterior, should be massaged after instillation of the ear drops to facilitate entry of the drops into the ear canal. A nurse is caring for a client who has a new colostomy. The client is being discharged and plans to live with her daughter. Which of the following responses by the nurse is appropriate when the daughter states that she doesn't know how she is going to care for her mother's colostomy? A. "It's quite simple. I'll make sure that her colostomy bag is clean before she leaves and you'll have no problems." B. "Is the colostomy care the only reason your mother is going to be living with you?" C. "A home health nurse will be stopping by tomorrow. If you have any questions, you can ask her." D. "What part of your mother's care concerns you?" D. "What part of your mother's care concerns you?" Rationale: A. In this item you, need knowledge of therapeutic and
thinking because you not only have to have knowledge of the specific techniques, but must also evaluate the statement in each option and determine if it represents a therapeutic or nontherapeutic technique. Passive responses tend to put the other person's concerns on hold, or sidestep the issue. In this scenario, the nurse is placing the responsibility for addressing the daughter's concerns on the home health nurse. This is not an appropriate response by the nurse because it uses the communication block of passiveness. D. In this item you, need knowledge of therapeutic and nontherapeutic communication techniques. Based on your understanding of these concepts, you can select the appropriate response by the nurse. This item requires critical thinking because you not only have to have knowledge of the specific techniques, but must also evaluate the statement in each option and determine if it represents a therapeutic or nontherapeutic technique. The use of effective communication techniques fosters trust and therapeutic relationships with clients, co-workers, and members of the interdisciplinary team. Clarification encourages the other person to further express concerns so they can be addressed. This is an appropriate response by the nurse because it uses the communication tool of clarification. A nurse is caring for a client who is diagnosed with bipolar disorder and is taking lithium. Which of the following serum lithium levels indicates the client's dosage is appropriate for maintenance therapy?
A. 0.25 mEq/L B. 0.75 mEq/L C. 1.5 mEq/L D. 2.25 mEq/L B. 0.75 mEq/L Rationale: A. To answer this item, you need knowledge of therapeutic serum lithium level levels. Based on your understanding of this information, you can select the option with the serum lithium level appropriate for maintenance therapy. This item requires foundational thinking because you have to recall knowledge of therapeutic serum lithium levels. This serum lithium level indicates the client's dosage is too low for maintenance therapy. B. To answer this item, you need knowledge of therapeutic serum lithium level levels. Based on your understanding of this information, you can select the option with the serum lithium level appropriate for maintenance therapy. This item requires foundational thinking because you have to recall knowledge of therapeutic serum lithium levels. Lithium is a mood-stabilizing medication used in the treatment of bipolar I acute and recurrent manic and depressive episodes. To achieve a therapeutic range, give 300 mg to 600 mg of lithium during the active phase. The therapeutic serum lithium level is between 0.8 mEq/L and 1.4 mEq/L. Maintenance levels of 0.4 to 1. 3 mEq/L are then achieved for clients who are prescribed lithium
C. Headache D. Seizures C. Headache Rationale: A. To answer this item, you need knowledge of lumbar punctures, as well as complications associated with the procedure. Based on an understanding of this information, you can identify the correct option. This item requires foundational thinking because you have to recall potential post procedure complications associated with a lumbar puncture. Hypothermia is not a manifestation that results from cerebrospinal fluid leakage at the puncture site following a lumbar puncture. Instead, the client can experience a slightly elevated temperature. B. To answer this item, you need knowledge of lumbar punctures, as well as complications associated with the procedure. Based on an understanding of this information, you can identify the correct option. This item requires foundational thinking because you have to recall potential postprocedure complications associated with a lumbar puncture. Polyuria is not a manifestation that results from cerebrospinal fluid leakage at the puncture site following a lumbar puncture. Instead, the client can experience difficulty voiding. C. To answer this item, you need knowledge of lumbar punctures, as well as complications associated with the procedure. Based on an understanding of this information, you
can identify the correct option. This item requires foundational thinking because you have to recall potential postprocedure complications associated with a lumbar puncture. Lumbar punctures are performed to withdraw cerebrospinal fluid found in the subarachnoid space for analysis. This is accomplished by inserting a needle into the lumbar subarachnoid space, typically between the third and fourth or fourth and fifth lumbar vertebrae. After the cerebrospinal fluid specimen has been removed, it is not uncommon for leakage of cerebrospinal fluid to continue at the puncture site. The leakage of cerebrospinal fluid leads to insufficient cerebrospinal fluid in the brain, which causes an inability to maintain appropriate mechanical stabilization of the brain. A headache is a manifestation experienced by 15 to 30% of clients following a lumbar puncture that results from cerebrospinal fluid leakage at the puncture site. These headaches are managed primarily with analgesics, hydration, and bed rest. D. To answer this item, you need knowledge of lumbar punctures, as well as complications associated with the procedure. Based on an understanding of this information, you can identify the correct option. This item requires foundational thinking because you have to recall potential postprocedure complications associated with a lumbar puncture. Seizures are not a manifestation that results from cerebrospinal fluid leakage at the puncture site following a lumbar puncture. Instead, a lumbar puncture can be performed in an attempt to determine the cause of seizures.
indicate the need for further teaching. B. In this item, you need nursing knowledge of cromolyn to recall information about the medication that should be included in client teaching. Based on an understanding of this information, you can identify which of the client statements is not accurate. This is a negatively worded item that asks you to select the option that indicates the client needs further teaching. You will learn more about negatively worded items in Module 4. This item requires foundational thinking because you have to recall knowledge to determine which of the client's statements about cromolyn was false. "I can't use my cromolyn nebulizer for a sudden asthma attack." is a true statement and does not indicate a need for further teaching. Cromolyn has a slow onset and will not relieve an acute asthma attack. A fast- acting bronchodilator should be given if the client is experiencing an acute bronchospasm. C. In this item, you need nursing knowledge of cromolyn to recall information about the medication that should be included in client teaching. Based on an understanding of this information, you can identify which of the client statements is not accurate. This is a negatively worded item that asks you to select the option that indicates the client needs further teaching. You will learn more about negatively worded items in Module 4.This item requires foundational thinking because you have to recall knowledge to determine which of the client's statements about cromolyn was false. "It will be several weeks before I notice an improvement in my asthma." is a true
statement and does not indicate a need for further teaching. Cromolyn is a prophylactic medication and the client will not feel the effects of it for several weeks; expecting otherwise can lead to noncompliance. Clients should be aware that taking cromolyn is necessary even though its effect is not immediately felt. D. In this item, you need nursing knowledge of cromolyn to recall information about the medication that should be included in client teaching. Based on an understanding of this information, you can identify which of the client statements is not accurate. This is a negatively worded item that asks you to select the option that indicates the client needs further teaching. You will learn more about negatively worded items in Module 4.This item requires foundational thinking because you have to recall knowledge to determine which of the client's statements about cromolyn was false. "I will use my cromolyn nebulizer before using my albuterol inhaler" is not a true statement and indicates a need for further teaching. Cromolyn is an inhalation agent used to reduce bronchial inflammation and for the prophylactic management of mild to moderate asthma. Education to the client about the medication should specifically include that it is not effective for quick relief, and that when administered routinely on a set schedule, both the frequency and intensity of asthma attacks is decreased. However, it is also important to note that cromolyn can reduce exercise-induced bronchospasms when administered 15 min prior to anticipated exertions. When both cromolyn and
vibrations caused by blood rushing through the artery, is appropriate for use when the blood pressure must be monitored frequently, and should not be taken on clients with conditions that can result in an inaccurate reading. A client who is recovering from a cardiac catheterization requires frequent blood pressure measurements. It is appropriate to perform an electronic blood pressure measurement on this client. B. In this item, you need nursing knowledge of how blood pressure measurement can be impacted by the stages of Parkinson's disease, hypotension, shivering, and cardiac catheterization. Additionally, specific knowledge of electronic blood pressure measurement is needed to select the correct option. This item requires critical thinking because you have to analyze the four clients and determine for whom an electronic blood pressure is appropriate. A client in stage 4 of Parkinson's disease has bilateral limb involvement and resting tremors. Associated tremors can result in an inaccurate reading by causing the sensor to detect these vibrations instead of blood rushing through the artery. It is not appropriate to perform an electronic blood pressure measurement on this client. C. In this item, you need nursing knowledge of how blood pressure measurement can be impacted by the stages of Parkinson's disease, hypotension, shivering, and cardiac catheterization. Additionally, specific knowledge of electronic blood pressure measurement is needed to select the correct option. This item requires critical thinking because you have to analyze the four clients and determine for whom an electronic
blood pressure is appropriate. Electronic blood pressure sensors are often unable to detect the vibrations associated with low blood pressure, which can result in an inaccurate reading. It is not appropriate to perform an electronic blood pressure measurement on this client. D. In this item, you need nursing knowledge of how blood pressure measurement can be impacted by the stages of Parkinson's disease, hypotension, shivering, and cardiac catheterization. Additionally, specific knowledge of electronic blood pressure measurement is needed to select the correct option. This item requires critical thinking because you have to analyze the four clients and determine for whom an electronic blood pressure is appropriate. Shivering can result in an inaccurate reading by causing the sensor to detect the outside interference instead of blood rushing through the artery. It is not appropriate to perform an electronic blood pressure measurement on this client. A nurse is caring for a client who weighs 132 lb and has been prescribed gentamicin 5 mg/kg/day by IV bolus in three equal doses. Available on hand is 40 mg/mL that is to be added to 50 mL 0.9% sodium chloride. How many mL should the nurse add to the solution per dose? 2.5 mL Rationale:
- 132 lb/2.2 = 60 kg
main common bile duct, similar to the joining of branches to a tree trunk. Bilirubin, created from the breakdown of heme in RBCs and the main pigment in bile, travels to the liver where the liver cells, known as hepatocytes, secretes it into bile. The bile then passes into the small ducts and then travels to the small intestine where bacteria break it down into urobilinogen to be excreted in the feces. Because of the progressive damage to the biliary tree, bile delivered to the small intestine is reduced, altering the metabolism of fats in infants who are diagnosed with biliary atresia. This difficulty in metabolizing fat leads to poor weight gain, instead of rapid weight gain. The nurse should not teach the parent that rapid weight gain is a clinical manifestation associated with the illness. B. In this item, you need knowledge of the anatomy of the biliary tree, as well as knowledge of the pathophysiology of biliary atresia. Based on this knowledge, you can identify a clinical manifestation the parent should be taught is associated with biliary atresia. This item requires critical thinking because you have to evaluate each finding in relation to the pathophysiology of biliary atresia. Biliary atresia is a progressive process that leads to destruction of the biliary tree. The biliary tree begins as many small ducts that join together into one main common bile duct, similar to the joining of branches to a tree trunk. Bilirubin, created from the breakdown of heme in RBCs and the main pigment in bile, travels to the liver where the liver cells, known as hepatocytes, secretes it into bile. The bile then passes into the small ducts and then travels to the
small intestine where bacteria break it down into urobilinogen to be excreted in the feces. The nurse should not teach the parent that tar-colored stools are a clinical manifestation associated with the illness. White or tan stools, not tar-colored stools, are a clinical sign of biliary atresia because of the lack of bilirubin in the intestinal tract. C. In this item, you need knowledge of the anatomy of the biliary tree, as well as knowledge of the pathophysiology of biliary atresia. Based on this knowledge, you can identify a clinical manifestation the parent should be taught is associated with biliary atresia. This item requires critical thinking because you have to evaluate each finding in relation to the pathophysiology of biliary atresia. Irritability, not lethargy, is a clinical sign of biliary atresia. It is often difficult to console or comfort infants who are diagnosed with biliary atresia. The nurse should not teach the parent that lethargy is a clinical manifestation associated with the illness. D. In this item, you need knowledge of the anatomy of the biliary tree, as well as knowledge of the pathophysiology of biliary atresia. Based on this knowledge, you can identify a clinical manifestation the parent should be taught is associated with biliary atresia. This item requires critical thinking because you have to evaluate each finding in relation to the pathophysiology of biliary atresia. Biliary atresia is a progressive process that leads to destruction of the biliary tree. The biliary tree begins as many small ducts that join together into one main common bile duct, similar to the joining of branches to a
