ATI LPN adult medical surgical 2023 | Nurselytic

Questions 61

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ATI LPN adult medical surgical 2023 Questions

Extract:

Nurses' Notes
Vital Signs
Laboratory Results
Provider Prescriptions
Day 1, 1000:

The client reports mid abdominal pain. Client reports pain as 7 on a scale of 0 to 10. The client states, "I haven't had a bowel movement in 4 days." The client states, "I also have vomited once or twice."

Physical Exam:

General: uncomfortable, grimacing

HEENT: dry mucous membranes

Cardiovascular: S1, S2, no murmur

Respiratory: bilateral breath sounds clear

Gastrointestinal: tenderness to palpation, high-pitched bowel sounds

Skin: no jaundice noted

Social history: drinks 1 to 2 glasses of wine daily. Client reports no tobacco use.


Question 1 of 5

A nurse is assisting with the care of the client Complete the following sentence by using the list of options. The nurse should first plan to.... followed by.....

Correct Answer: A,D

Rationale: The nurse should first ensure the nasogastric tube is correctly placed to address vomiting and obstruction, followed by requesting an antiemetic to manage nausea.

Extract:

Nurses' Notes
Vital Signs
Laboratory Results
Provider Prescriptions
Day 1, 1000:

The client reports mid abdominal pain. Client reports pain as 7 on a scale of 0 to 10. The client states, "I haven't had a bowel movement in 4 days." The client states, "I also have vomited once or twice."

Physical Exam:

General: uncomfortable, grimacing

HEENT: dry mucous membranes

Cardiovascular: S1, S2, no murmur

Respiratory: bilateral breath sounds clear

Gastrointestinal: tenderness to palpation, high-pitched bowel sounds

Skin: no jaundice noted


Question 2 of 5

Which of the following actions should the nurse assist with?

Correct Answer: C

Rationale: Reinforcing preoperative teaching is appropriate given the potential need for surgery due to suspected bowel obstruction, as indicated by symptoms.

Extract:

Nurses' Notes
Vital Signs
Laboratory Results
Provider Prescriptions
Day 1, 1000:

The client reports mid abdominal pain. Client reports pain as 7 on a scale of 0 to 10. The client states, "I haven't had a bowel movement in 4 days." The client states, "I also have vomited once or twice."

Physical Exam:

General: uncomfortable, grimacing

HEENT: dry mucous membranes

Cardiovascular: S1, S2, no murmur

Respiratory: bilateral breath sounds clear

Gastrointestinal: tenderness to palpation, high-pitched bowel sounds

Skin: no jaundice noted

Social history: drinks 1 to 2 glasses of wine daily. Client reports no tobacco use.

Day 1, 1100:

Morphine administered as prescribed. IV fluids with potassium supplements initiated. Nasogastric tube inserted into left nare and set to low wall suction.

Day 4, 1000:

Client reports that abdominal pain has decreased to 3 on a scale of 0 to 10. Client states, "I feel less nauseous today and haven't vomited since yesterday." Client reports having a small bowel movement early this morning.

Physical exam:

General: Appears more comfortable, not grimacing.

HEENT: Mucous membranes moist.

Cardiovascular: S1, S2, no murmur.

Respiratory: Bilateral breath sounds clear.

Gastrointestinal:

Mild tenderness to palpation.

Bowel sounds present and more regular, less high-pitched.

Skin: No jaundice noted, skin warm and dry.

The nurse continues to assist with the care of the client.


Question 3 of 5

The nurse continues to assist with the care of the client. Which of the following findings indicates that the client's condition has improved?

Correct Answer: D,E,F

Rationale: Decreased pain (from 7 to 3), reduced nausea, and more regular bowel sounds indicate improvement in the client's condition, likely due to resolution of obstruction.

Extract:


Question 4 of 5

A nurse is assisting with the care of a client who had a bronchoscopy 12 hr ago. Which of the following findings should the nurse report to the provider?

Correct Answer: A

Rationale: Inspiratory stridor indicates possible airway obstruction or swelling post-bronchoscopy, a serious complication requiring immediate reporting.

Question 5 of 5

A nurse is collecting data from a client who underwent a thyroidectomy 4 hr ago. Which of the following client findings indicates a complication of the procedure?

Correct Answer: D

Rationale: Tingling of the fingers suggests hypocalcemia due to parathyroid gland damage during thyroidectomy, a potential complication.

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