Questions 43

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ATI RN Adult Med-Surg 2023 Questions

Extract:

History and Physical
Nurses' Notes
Vital Signs
1000:

Client reports after eating breakfast this morning at 0630 that they began feeling tightness in chest that radiates to left arm. History:

Hyperlipidemia, hypertension, type 2 diabetes mellitus. Non-smoker. Denies use of alcohol or recreational drug use.


Question 1 of 5

A nurse is admitting a client who reports tightness in their chest that radiates to left arm. Select the findings below that would indicate that the client has a potential problem.

Correct Answer: A, C, G

Rationale: The choices indicate a cardiac issue; symptoms suggest acute coronary syndrome.

Extract:

Medical history
Vital Signs
Physical Examination
Diagnostic Results
Hemochromatosis


Question 2 of 5

A nurse is admitting a middle adult client who has cirrhosis. The nurse is assessing the client 24 hr later. How should the nurse interpret the findings? For each finding, click to specify whether the finding is unrelated to the diagnosis, a sign of potential improvement, or a sign of potential worsening condition.

Findings 12 hr later Unrelated to diagnosis Indication of potential improvement Indication of potential worsening of condition
Elevated iron levels
Increased albumin level
Productive cough
Ascites
Hematemesis
Spontaneous bruising

Correct Answer:

Rationale: Specific answers not provided; D, E, F indicate worsening cirrhosis complications.

Extract:

Vital Signs
Diagnostic Results
Physical Examination
Medical History
Blood pressure 106/64 mm Hg

Heart rate 95/min

Respiratory rate 20/min

Temperature 37.8° C (100° F)

Oxygen saturation 95% on O2 at 3 L/min via nasal cannula


Question 3 of 5

A nurse is caring for an older adult client who was admitted with a urinary tract infection. The nurse is assessing the client 12 hr later. How should the nurse interpret the findings? For each finding, click to specify whether the finding is unrelated to the diagnosis, a sign of potential improvement, or a sign of potential worsening condition.

Findings 12 hr later Unrelated to diagnosis Indication of potential improvement Indication of potential worsening of condition
Oxygen saturation 96% at 2 L/min via nasal cannula
Disoriented to person, place, and time
Blood pressure 100/50 mm Hg
Hct 45%
Pink-tinged urine
Butterfly rash

Correct Answer:

Rationale: Specific answers not provided; A likely indicates improvement, B and C suggest worsening.

Extract:

A nurse is caring for a client.
Medical History
Nurses' Notes
Vital Signs
Cerebrovascular accident 2 years ago

Coronary artery disease

Hypertension

Hyperlipidemia


Question 4 of 5

A nurse is reviewing the client's medical record. After reviewing the medical record, which of the following actions should the nurse plan to take? For each potential provider's prescription, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the client.

Potential PrescriptionAnticipatedNonessentialContraindicated
Encourage the client to cough.
Keep the client's head in a midline position.
Elevate the head of the bed.
Assist the client to the bathroom.
Initiate seizure precautions.
Decrease oxygen to 1.5 L/min via nasal cannula.

Correct Answer:

Rationale: Specific answers not provided; anticipated actions likely include B and C due to history of cerebrovascular accident.

Extract:


Question 5 of 5

A nurse is caring for a client who has an arteriovenous graft. Which of the following findings indicates adequate circulation of the graft?

Correct Answer: A

Rationale: A palpable thrill indicates blood flow through the graft, confirming adequate circulation.

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