ATI RN
ATI Advanced Med Surg Exam 4 Questions
Extract:
Vital Signs
Blood pressure 180/90 mm Hg
Heart rate 105/min
Temperature 37.1° C (98.8 F)
Respirations 18min; labored
Pulse oximetry 94 on 2L nasal cannula
Medical History
History of coronary artery disease
Type 2 diabetes mellitus
Renal failure
Renal transplant 6 weeks ago
Nurses Notes
The client reports worsening fatigue over the last 3 days. The client also reports loss of appetite, denies nausea or vomiting.
On assessment, the client appears pale, lung and heart sounds within defined limits. Abdomen is tender in area of incision from transplant Bowel sounds are hypoactive in all 4 quadrants. Bilateral pedal pulses +2. +1 edema in bilateral lower extremities. Client reports that for the last 2 days they have only urinated twice per 24-hour period.
Diagnostic Results
BUN 25 mg/dL (10 to 20 mg/dL)
Creatine 2.0 mg/dL (0.5 to 1.3 mg/dL)
Hemoglobin 15 mmol/L (12 to 18 mmol/L)
Hematocrit 45% (37% to 52%)
Potassium 5.2 mEq/L (3.5 to 5.0 mEq/L)
Sodium 145 mEq/L (136 to 145 mEq/L)
Question 1 of 5
A nurse is caring for a client who is admitted to the emergency department for fatigue. Which of the following findings indicate that the client may be experiencing transplant rejection? (Select all that apply).
Correct Answer: A,B,E,F
Rationale: A: Incision tenderness indicates inflammation. B: Edema suggests kidney issues. E: High creatinine indicates rejection. F: Hypoactive bowels may indicate reduced perfusion.
Extract:
Question 2 of 5
The nurse teaches patients about drug therapy after a kidney transplant. Which statement by the patient would indicate a need for further instructions?
Correct Answer: A
Rationale: The statement about stopping Tacrolimus is incorrect as it is typically required lifelong to prevent organ rejection.
Extract:
Physical Examination
January:
Weight 70.5 kg (155 lb)
BMI 24
February:
Weight 69 kg (152 lb)
BMI 23
Diagnostic Results
January:
Complete Blood Count:
RBC count 4.2 (4.2 to 5.4)
WBC count 5,500/mm3 (5,000 to 10,000/mm3)
Hgb 12 g/dl (12 g/dL to 16 g/dL)
Het 37% (37% to 47%)
Platelet count: 150,000/mm2 (150,000 to 400,000/mm
February:
Complete Blood Count
WBC count: 4,500/mm2 (5,000 to 10.000/mm3)
RBC count 4 (4.2 to 5.4)
Hgb: 14 g/dL (15 g/dl to 16 g/dl
Het 36 (376 to 4796)
Platelet count: 140,000/mm(150.000 to 400,000/mm3)
Nurses' Notes
January:
Client reports fatigue and nausea following chemotherapy treatments. States, "It just makes me not want to eat. When I do eat, the food taste funny."
Client teaching: Instructed client to attempt to eat small meals several times daily, to eat food cold or at room temperature, to avoid fried foods. Encourage client to rest before eating meals.
Oral mucosa is inflamed.
Client teaching: Instructed client to avoid mouthwashes that contain alcohol, to increase water intake to 2 or more liters daily, and to avoid hot foods.
Reviewed laboratory findings and stressed the need to protect self from illness due to immunosuppression.
Client teaching: Instructed client to not eat raw or undercooked meat, to drink only pasteurized milk, and to boil water before drinking it take temperature daily and report fever, avoid crowds, wash hands frequently with antimicrobial soap.
Reviewed laboratory findings and stressed need for bleeding precautions. Client states, "I’ve had bleeding from these ulcers in my mouth.”
Client teaching Use an electric razor take a stool softener if constipation occurs, avoid coarse-textured foods.
February
Client has experienced weight loss of 1.5 kg (3 B), has experienced decrease in hct and high, WBC and platelet count.
Client reports still not able to consume much food has increased intake
of water. Oral mucosa with less inflammation.
Client reports no bleeding episodes.
Question 3 of 5
A nurse is caring for a client who has cancer and is undergoing chemotherapy. Which of the following assessments indicates an improvement in the client's condition? (Select all that apply.)
Correct Answer: A,C,D
Rationale: A: A decrease in WBC count may indicate reduced chemotherapy-induced immunosuppression. C: Absence of bleeding episodes suggests improved mucosal integrity. D: Reduced oral inflammation indicates effective interventions. E: Weight loss does not indicate improvement.
Extract:
Question 4 of 5
A nurse is caring for a client who has heart failure and a prescription for digoxin 125 mcg PO daily. Available is digoxin PO 0.25 mg/tablet. How many tablets should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)
Correct Answer: 0.5
Rationale: 125 mcg = 0.125 mg. Available is 0.25 mg/tablet. 0.125 ÷ 0.25 = 0.5 tablets.
Question 5 of 5
A nurse is teaching a group of clients about first aid care for a bee sting. Which of the following information should the nurse include in the teaching?
Correct Answer: C
Rationale: Scraping the stinger prevents further venom release, reducing reaction severity.