ATI RN
ATI RN Adult Medical Surgical 2023 V Questions
Extract:
Question 1 of 5
A nurse is assessing a client who has myasthenia gravis. Which of the following client statements should indicate to the nurse that the client needs a referral for occupational therapy?
Correct Answer: C
Rationale: Difficulty brushing hair indicates impaired upper extremity function, which occupational therapy can address to improve activities of daily living.
Extract:
History and Physical
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.
Nurses' Notes
1000:
Client reports tightness in chest that radiates to left arm. States pain as 7 on a scale of 0 to 10. Started to feel nauseous after breakfast. Client states, "I had scrambled eggs and bacon like I do every morning." Client is diaphoretic and short of breath. Heart rate irregular and tachycardic. Alert and oriented to person, place, and time. Lungs clear to auscultation in all lobes. Bowel sounds are present in all 4 quadrants. +1 pedal pulses. Skin is cool to touch. Capillary refill less than 2 seconds.
Vital Signs
1000:
• Temperature 37.1° C (98.8° F)
• Heart rate 110/min and irregular
• Respiratory rate 24/min
• Blood pressure 164/80 mm Hg
• Oxygen saturation 93% on room air
Diagnostic Results
1000:
• Myoglobin 100 mcg/L (less than 90 mcg/L)
• Creatine kinase 180 units/L (55 to 170 units/L)
• Troponin T 0.40 ng/mL (less than 0.1 ng/mL)
• Troponin 10.35 ng/mL (less than 0.03 ng/mL)
• Cholesterol 244 mg/dL (less than 200 mg/dL)
• Triglycerides 180 mg/dL (40 to 160 mg/dL)
• LDL cholesterol 148 mg/dL (less than 130 mg/dL)
• HDL cholesterol 42 mg/dL (greater than 45 mg/dL)
• C-reactive protein 2 mg/mL (less than 1.0 mg/mL)
• Blood glucose 103 mg/dL (74 to 106 mg/dL)
12-lead electrocardiogram: tachycardia with ST segment elevation and T wave changes
Chest x-ray: lungs are clear in all lobes
Provider prescriptions
1020:
• Nitroglycerin 0.5 mg SL may repeat every 5 min up to 3 doses as needed for chest pain
• Aspirin 160 mg PO daily
• Morphine 6 mg IV bolus every 3 hr PRN pain
• Metoprolol 25 mg PO every 6 hr x 48 hr, then metoprolol 100 mg PO twice daily
• Initiate peripheral IV site
• 0.9% sodium chloride 50 mL/hr by continuous IV infusion
• Oxygen at 2 L/min via nasal cannula if oxygen saturation is less than 90%
• Schedule stat echocardiogram
• 2 g sodium diet
Question 2 of 5
The nurse is reviewing the client's medical record. For each potential provider's prescription, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the client.
| Options | Anticipated | Nonessential | Contraindicated |
|---|---|---|---|
| Metoprolol 5 mg every 2 to 3 min up to three doses | |||
| Oxygen at 2 L/min via nasal cannula | |||
| Draw electrolytes along with Hgb and Hct | |||
| Morphine 6 mg IV bolus every 3 hr as needed for pain | |||
| Nitroglycerin 0.4 mg SL now may repeat every 5 min up to 3 doses | |||
| Obtain daily weight | |||
| Atropine 0.5 mg IV bolus every 5 min up to 2 mg |
Correct Answer: B,C,D,E,F
Rationale: Oxygen, labs, morphine, nitroglycerin, and weight monitoring support acute coronary syndrome management; metoprolol IV dosing and atropine are inappropriate.
Extract:
Question 3 of 5
A nurse is teaching a client who has asthma about how to use a metered-dose inhaler with a spacer. Which of the following information should the nurse include in the teaching?
Correct Answer: B
Rationale: Holding the breath for 10 seconds allows medication to deposit in the lungs, maximizing effectiveness.
Extract:
History and Physical
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.
Nurses' Notes
1000:
Client reports tightness in chest that radiates to left arm. States pain as 7 on a scale of 0 to 10. Started to feel nauseous after breakfast. Client states, "I had scrambled eggs and bacon like I do every morning." Client is diaphoretic and short of breath. Heart rate irregular and tachycardic. Alert and oriented to person, place, and time. Lungs clear to auscultation in all lobes. Bowel sounds are present in all 4 quadrants. +1 pedal pulses. Skin is cool to touch. Capillary refill less than 2 seconds.
Vital Signs
1000:
• Temperature 37.1° C (98.8° F)
• Heart rate 110/min and irregular
• Respiratory rate 24/min
• Blood pressure 164/80 mm Hg
• Oxygen saturation 93% on room air
Diagnostic Results
1000:
• Myoglobin 100 mcg/L (less than 90 mcg/L)
• Creatine kinase 180 units/L (55 to 170 units/L)
• Troponin T 0.40 ng/mL (less than 0.1 ng/mL)
• Troponin 10.35 ng/mL (less than 0.03 ng/mL)
• Cholesterol 244 mg/dL (less than 200 mg/dL)
• Triglycerides 180 mg/dL (40 to 160 mg/dL)
• LDL cholesterol 148 mg/dL (less than 130 mg/dL)
• HDL cholesterol 42 mg/dL (greater than 45 mg/dL)
• C-reactive protein 2 mg/mL (less than 1.0 mg/mL)
• Blood glucose 103 mg/dL (74 to 106 mg/dL)
12-lead electrocardiogram: tachycardia with ST segment elevation and T wave changes
Chest x-ray: lungs are clear in all lobes
Provider prescriptions
1020:
• Nitroglycerin 0.5 mg SL may repeat every 5 min up to 3 doses as needed for chest pain
• Aspirin 160 mg PO daily
• Morphine 6 mg IV bolus every 3 hr PRN pain
• Metoprolol 25 mg PO every 6 hr x 48 hr, then metoprolol 100 mg PO twice daily
• Initiate peripheral IV site
• 0.9% sodium chloride 50 mL/hr by continuous IV infusion
• Oxygen at 2 L/min via nasal cannula if oxygen saturation is less than 90%
• Schedule stat echocardiogram
• 2 g sodium diet
Question 4 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,E
Rationale: Pain, diaphoresis, shortness of breath, and cool skin suggest acute coronary syndrome.
Extract:
Medical History
• Type 2 diabetes mellitus
• Hypertension, controlled by diuretic and ace-inhibitor therapy Osteoarthritis
Medication Administration Record
• Home medications:
• Metformin 1,000 mg PO BID
• Lisinopril 20 mg PO daily
• Celecoxib 100 mg PO BID
Diagnostic Results
Preoperative laboratory results: Basic Metabolic Profile (BMP):
• Glucose 190 mg/dL (74 to 106 mg/dL)
• BUN 16 mg/dL (10 to 20 mg/dL)
• Creatinine 0.8 mg/dL (0.5 to 1 mg/dL)
• Hemoglobin A1C 9.5% (Poor diabetic control: greater than 99%)
Current laboratory results:
Basic Metabolic Profile (BMP):
• Glucose 280 mg/dl (74 to 106 mg/dl)
• BUN 15 mg/dL (10 to 20 mg/dL)
• Creatinine 0.7 mg/dL (0.5 to 1 mg/dl)
Vital Signs
Preoperative:
• Temperature 36.4° C (97.6° F)
• Heart rate 82/min
• Respiratory rate 20/min
• Blood pressure 126/74 mm Hg
• Oxygen saturation 95% on room air
Current:
• Temperature 37 2 C (99° F)
• Heart rate 92/min
• Respiratory rate 22/min
• Blood pressure 136/85 mm Hg
• Oxygen saturation 98% on 2 L/min nasal cannula
Question 5 of 5
A nurse is caring for a client who is postoperative following a total knee arthroplasty. Complete the following sentence by using the lists of options. The client in a higher pick for..... as evidenced by the client's......
Correct Answer: A,F
Rationale: Elevated blood glucose (280 mg/dL) increases infection risk post-surgery, as hyperglycemia impairs wound healing and immune response.