ATI LPN
PN Adult Medical Surgical 2023 Questions
Extract:
Exhibit 1 Exhibit 2 Exhibit 3 Exhibit 4
Medical History
Today, 0700:
Admitting Diagnosis: Heart Failure
Past medical history of heart failure, coronary artery disease, sleep apnea
Client reports diarrhea, dry mouth, and unusual thirst for the past three days
Question 1 of 5
A nurse is assisting in the care of a male client who has a new prescription for furosemide. Which of the following client findings should the nurse identify as a contraindication to the administration of furosemide?
Correct Answer: A
Rationale: Furosemide, a loop diuretic, treats heart failure but depletes potassium, risking hypokalemia. A low potassium level (e.g., <3.5 mEq/L) contraindicates its use hypokalemia causes arrhythmias, especially with heart failure's cardiac strain, per pharmacology standards. Blood pressure matters hypotension may worsen with diuresis but isn't a direct contraindication unless extreme. Digoxin use heightens hypokalemia risk (enhancing toxicity), but potassium level drives the decision. The client's report of diarrhea and thirst suggests dehydration, a caution, not a strict contraindication. Low potassium demands correction (e.g., supplements) before furosemide, preventing lethal complications like ventricular fibrillation, making it the critical finding to identify.
Extract:
VITAL SIGNS
Day 1:
TEMPERATURE 36° C (96.8° F)
BLOOD PRESSURE 140/80 mm Hg
HEART RATE 98/min
RESPIRATORY RATE 24/min
OXYGEN SATURATION 97% on room air
Day 2, 0800:
TEMPERATURE 37° C (98.6° F)
BLOOD PRESSURE 122/60 mm Hg
HEART RATE 85/min
RESPIRATORY RATE 18/min
OXYGEN SATURATION 98% on room air
Day 2, 1600:
Findings
• Dyspnea
• Tingling sensation to right foot
• Increased pain at incision site
• Swelling at incision site
Acute compartment syndrome
• Dyspnea
• Tingling sensation to right foot
• Increased pain at incision site
• Swelling at incision site
Infection
• Dyspnea
• Tingling sensation to right foot
• Increased pain at incision site
• Swelling at incision site
Fat embolism syndrome
• Dyspnea
• Tingling sensation to right foot
• Increased pain at incision site
• Swelling at incision site
Question 2 of 5
A nurse is assisting in the care of a client who is postoperative following an open reduction internal fixation of the right tibia. Which finding is consistent with acute compartment syndrome?
Correct Answer: A, C
Rationale: Acute compartment syndrome post-ORIF arises from pressure buildup in muscle compartments, impairing perfusion. Increased pain at the incision site severe, unrelieved by analgesics, and disproportionate to the procedure is a hallmark, reflecting nerve and tissue ischemia. Dyspnea suggests fat embolism syndrome, a separate complication from marrow release, not compartment pressure. Tingling indicates nerve compression, a later sign, but pain precedes it in the 6 Ps (pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia). Swelling occurs, but pain's intensity and persistence distinguish compartment syndrome from normal postoperative edema. Early recognition of escalating pain prompts fasciotomy, preventing necrosis, making it the most consistent finding per orthopedic emergency protocols.
Extract:
Question 3 of 5
A nurse is reinforcing teaching for a client who was admitted with an exacerbation of COPD. Which of the following should the nurse include in the client teaching?
Correct Answer: A
Rationale: Small, frequent meals reduce diaphragm pressure and breathing effort in COPD. Caloric reduction isn't advised, oxygen adjustments need orders, and prednisone requires tapering.
Extract:
Vital Signs
Today, 0700:
Blood pressure 122/68 mm Hg
Heart rate 99/min
Respiratory rate 20/min
Temperature 36.4° C (97.6° F)
Laboratory Results
Today, 0700:
Potassium 3.2 mEq/L (3.5 to 5 mEq/L)
Hct 44% (42% to 52%)
BUN 19 mg/dL (10 to 20 mg/dL)
Question 4 of 5
Which of the following client findings should the nurse identify as a contraindication to the administration of furosemide? (Client with potassium 3.2 mEq/L)
Correct Answer: A
Rationale: Hypokalemia (3.2 mEq/L) is a contraindication as furosemide can worsen it, risking arrhythmias.
Extract:
History and Physical
1000:
Client reports generalized weakness and increased fatigue over the past few months.
Client states they become short of breath after climbing a flight of stairs and are having difficulty keeping up with their grandchildren.
History of rheumatoid arthritis. Reports taking naproxen 500 mg twice a day.
Client reports they follow a vegan diet.
Denies pain or discomfort.
Bilateral breath sounds clear and present throughout.
Mucous membranes pale.
Apical pulse rapid, regular.
Question 5 of 5
For each potential provider's prescription, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the client. Prescription: Administer an iron supplement.
| Potential Prescription | Anticipated | Nonessential | Contraindicated |
|---|---|---|---|
| Administer an iron supplement | |||
| Collaborate with a nutritional consultant. | |||
| Place the client on a low sodium diet. | |||
| Restrict fluid Intake. |
Correct Answer:
Rationale: Low Hct, Hgb, and ferritin indicate iron deficiency anemia, making iron supplementation anticipated.