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.
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