ATI RN
ATI Med Surg 2 Respiratory exam Questions
Extract:
History and Physical
The client has a history of type 1 diabetes mellitus for 16 years, which is managed with insulin at bedtime and before each meal. The client measures capillary blood glucose twice daily. He had a motor-vehicle crash 3 years prior.
Nurses Notes
The client is lethargic and rouses with physical stimulation. His Glasgow Coma Scale score has decreased from 14 to 12. Auscultation of the lungs reveals rales in the right lower lobe. The right upper lobe is diminished but clear. Kussmaul respirations are noted. An 18-gauge IV in the right forearm is edematous and cool to touch. Capillary refill is 3 seconds. He has dry mucous membranes and decreased skin turgor.
Vital Signs
• Supine blood pressure: 100/70 mm Hg
• Sitting blood pressure: 85/50 mm Hg
• Heart rate: 120/min
• Respiratory rate: 24/min
• Temperature: 37.9°C (100.2°F)
• Oxygen saturation: 95% on room air
Medical History
The client was admitted to the unit from the emergency department. The client's partner reports lethargy, vomiting, diarrhea, and fever lasting for 2 days.
Diagnostic Results
• Casual blood glucose: 580 mg/dL (normal: <200 mg/dL)
• Sodium: 152 mEq/L (normal: 136-145 mEq/L)
• Potassium: 5.3 mEq/L (normal: 3.5-5.0 mEq/L)
• BUN: 32 mg/dL (normal: 10-20 mEq/L)
• Creatinine: 1.8 mg/dL (normal: 0.5-1.3 mg/dL)
• Serum pH: 7.2 (normal: 7.35-7.45)
• HCO3-: 13 mEq/L (normal: 21-28 mEq/L)
• Urine reagent strip testing: pH 4.4 (normal: 4.6-8.0), Specific gravity: 1.036 (normal: 1.005-1.030), Ketones: positive (negative), Glucose: present (none)
• Glycosylated hemoglobin: 9.69% (normal: <7.9% indicates good diabetic control)
ECG Findings
ECG indicates tachycardia with a prolonged PR interval, widened QRS, and peaked T waves.
Question 1 of 5
A nurse is admitting a 45-year-old male client who has type 1 diabetes mellitus in the emergency department. Select the findings that require immediate attention.
Correct Answer: A,C,F,G,H
Rationale: The Glasgow Coma Scale score decrease indicates worsening neurological status. Low bicarbonate suggests metabolic acidosis. Hypotension indicates hemodynamic instability. ECG findings suggest hyperkalemia. Hypernatremia requires prompt correction.
Extract:
Question 2 of 5
A nurse admits a client to the emergency department who reports nausea and vomiting that worsens when he lies down. Antacids do not help. The provider suspects acute pancreatitis. Which of the following laboratory test results should the nurse expect to see?
Correct Answer: D
Rationale: Increased serum amylase is a hallmark of acute pancreatitis as the damaged pancreas releases more amylase into the blood.
Question 3 of 5
A nurse is reviewing the arterial blood gas values for a client. The pH is 7.32, PaCO₂ 48 mm Hg and the HCO₃ is 23 mEq/L. The nurse should recognize that these findings indicate which of the following acid-base balances?
Correct Answer: D
Rationale: Respiratory acidosis is identified by a low pH, elevated PaCO₂, and normal HCO₃, aligning with the provided values.
Question 4 of 5
A nurse is preparing discharge instructions for a client who has cirrhosis of the liver. Which of the following statements should be included in the education materials?
Correct Answer: C
Rationale: Avoiding high-sodium foods is crucial because cirrhosis often leads to fluid retention and ascites, which can be exacerbated by a high-sodium diet.
Question 5 of 5
A nurse is providing teaching to an adolescent who has type 1 diabetes mellitus. Which of the following should the nurse include in the teaching?
Correct Answer: A
Rationale: Obtaining an influenza vaccine annually is crucial for individuals with type 1 diabetes to reduce the risk of infections that can exacerbate their condition.