ATI LPN
ATI LPN Med Surg Level 3 II Questions
Extract:
Medical History
Client has a history of left-sided heart failure, hypertension, chronic atrial fibrillation with controlled rate, coronary artery disease (coronary bypass surgery 5 years ago).
Client was admitted to hospital directly from provider office visit. Reports increasing weakness and shortness of breath with minimal exertion.
Diagnostic Results
Basic Metabolic Profile (BMP):
Glucose 148 mg/dL (200 mg/dL)
BUN 18 mg/dL (10 to 20 mg/dL)
Creatinine 0.94 mg/dL (0.05 to 1.3 mg/dL)
Sodium 142 mEq/L (136 to 145 mEq/L)
Potassium 4.4 mEq/L (3.5 to 5 mEq/L)
Chloride 100 mEq/L (98 to 106 mEq/L)
Calcium 9.6 mg/dL (9 to 10.5 mg/dL)
Phosphorus 4,2 mg/dL (3 to 4.5 mg/dL)
Cardiac Enzyme Laboratory Report:
TROPONIN T 0.06 ng/mL (less than 0.1 ng/mL)
TROPONIN 10.1 ng/mL (less than 0.3 ng/mL)
B-natriuretic peptide (BNP) 800 ng/mL (less than 100 ng/mL)
ECG Report: Atrial fibrillation, rate 135/min
Chest x-ray Report: Cardiomegaly with bilateral pleural chest effusions indicative of heart failure.
Nurses Notes
Physical Assessment:
Neurological: Client is alert, oriented x 3. Follows simple commands, responds to questions appropriately, moves all extremities well.
Cardiac: Heart rate is elevated at 138 beats/min, irregular rhythm. Pulses to lower extremities irregular and weak. Telemetry monitor showing atrial fib with rapid ventricular response (RVR). Client denies chest pain or discomfort.
Respiratory: Respirations at 28/min, O2 saturation 93% on 2 L via nasal cannula. Frequent cough noted with pink-tinged sputum. Client denies shortness of breath at this time.
Gastrointestinal: Bowel sounds active x 4 quadrants. States last bowel movement this morning with no irregularities.
Genitourinary: States no problems voiding. Urine clear, yellow.
Vital Signs
Temperature 37.2° C (98.9° F)
Heart rate 138/min
Respiratory rate 28/min
Blood pressure 96/75 mm Hg
O2 saturation 93% on 2 L/min via nasal cannula
Question 1 of 5
A nurse is assisting with the admission of a client who has a history of heart failure. Which of the following findings require immediate follow-up by the nurse? Select all that apply.
Correct Answer: B,D,E,F,G
Rationale: Vital signs (elevated heart and respiratory rates, low BP) indicate instability. Elevated troponin (10.1 ng/mL) suggests myocardial injury. High BNP (800 ng/mL) confirms worsening heart failure. Respiratory findings (pink-tinged sputum, high respiratory rate) suggest pulmonary congestion. ECG showing atrial fibrillation with RVR (135/min) requires rate control to prevent complications.
Extract:
Question 2 of 5
When a nurse obtains an unusually low blood pressure measurement for a client whose blood pressure is generally elevated, she considers the possibility of a problem with her technique. Which of the following sources of error should she consider as a possible cause of the low reading?
Correct Answer: B
Rationale: Positioning the arm above heart level can falsely lower BP readings. The arm should be at heart level for accuracy.
Question 3 of 5
A nurse is collecting data about a client's cardiac functioning. The nurse auscultates an S3 sound. Which of the following causes should the nurse suspect?
Correct Answer: B
Rationale: An S3 sound, a ventricular gallop, occurs in early diastole due to rapid ventricular filling, often indicating heart failure or fluid overload.
Question 4 of 5
A nurse is caring for a client who has hypertension and is to start taking atenolol (a betablocker) which also reduces the workload of the heart. The nurse should instruct the client to monitor for which of the following findings as an adverse effect of this medication?
Correct Answer: A
Rationale: Atenolol can cause bradycardia by slowing the heart rate, a key adverse effect to monitor.
Question 5 of 5
A nurse is administering nicardipine to a client who has a BP of 180/120 mm Hg. Which of the following actions should the nurse take first?
Correct Answer: D
Rationale: In a hypertensive crisis, frequent BP monitoring (every 5 minutes) is critical to assess nicardipine's effectiveness and prevent overly rapid BP reduction.