ATI RN
ATI RN Adult Medical Surgical 2023 V Questions
Extract:
Medical History
• Dehydration
• Hyperlipidemia
• Hypertension
• Coronary artery disease (CAD)
Diagnostic Results
• WBC count 14,000/mm3 (5,000 to 10,000/mm3)
• Hgb 14 g/dL (12 to 16 g/dL)
• Hct 40% (34 to 47%)
• Sodium 132 mEq/L (136 to 146 mEq/L)
• Potassium 6.2 mEq/L (3.5 to 5 mEq/L)
• Calcium 10 mg/dL (9 to 10.5 mg/dL)
• BUN 20 mg/dL (10 to 20 mg/dL)
• Albumin 2.8 g/dL (3.5 to 5 g/dL)
• Fasting blood glucose 140 mg/dL (74 to 106 mg/dL)
• Triglycerides 134 mg/dL (34 to 160 mg/dL)
Nurses' Notes
Client is lying in bed. Awake, alert, and oriented to time, place, and person. Client is febrile and reports weakness. Receiving TPN via central line in left antecubital. Client is NPO and has had diarrhea x3 in past 4 hr. Crackles auscultated in posterior lobes. Client has a productive cough and sputum is yellow in color. Client receiving 2 U/min oxygen via nasal cannula with an oxygen saturation of 90%. Abdomen is distended and tender. Active range of motion to all extremities. Denies pain at this time.
Question 1 of 5
A nurse is caring for a client who is receiving TPN. Which of the following actions should the nurse take? For each potential nursing intervention, click to specify if the potential intervention is anticipated, nonessential, or contraindicated for the client.
| Options | Anticipated | Nonessential | Contraindicated |
|---|---|---|---|
| Notify provider to increase TPN rate/hr. | |||
| Decrease the client's oxygen to 1.5 L/min oxygen via nasal cannula. | |||
| Obtain client weight twice daily. | |||
| Request a prescription for insulin. | |||
| Request an antibiotic to be administered. | |||
| Have 3 nurses verify the TPN solution prescription. |
Correct Answer: C,D,E
Rationale: Weight monitoring tracks fluid balance, insulin addresses hyperglycemia, and antibiotics treat suspected infection (fever, elevated WB
C).
Extract:
Question 2 of 5
A nurse is planning care for a client who has GERD and reports regurgitation after eating. Which of the following tests should the nurse anticipate the provider to prescribe for the client?
Correct Answer: B
Rationale: A barium swallow visualizes the esophagus, helping diagnose GERD by showing reflux or structural issues.
Extract:
Nurses' Notes
0900:
Client came to the emergency department this morning and reports not feeling well for the last 12 hr and increasing blood glucose. Client has a history of type 1 diabetes mellitus and hypertension. Client weight is 88 kg (194 lb). The client was recently treated for bronchitis and pneumonia. Client reports nausea and decreased appetite.
Client is alert and orientated x 4, heart and lung sounds are clear. Client states that they have been frequently urinating and are extremely thirsty. Bowel sounds are hyperactive in all 4 quadrants. Bilateral pedal pulses 1+. Slight tenting of skin. Peripheral IV established and labs drawn.
Vital Signs
0900:
• Temperature 36.8° C (98.2° F)
• Pulse rate 110/min
• Respiratory rate 18/min
• Blood pressure 96/65 mm Hg
• Oxygen saturation 96% on room air
Laboratory Results
0915:
• Blood glucose 468 mg/dL (74 to 106 mg/dL)
• pH 7.30 (7.35 to 7.45)
• Potassium 5.5 mEq/L (3.5 to 5 mEq/L)
• Sodium 138 mEq/L (136 to 145 mEq/L)
• Chloride 101 mEq/L (98 to 106 mEq/L) BUN 21 mg/dL (10 to 20 mg/dL)
• Creatinine 1.7 mg/dL (0.5 to 1.1 mg/dL)
• Urine dipstick positive for ketones (negative)
Question 3 of 5
A nurse is caring for a client in the emergency department. The nurse understands that the client is at risk of developing which of the following complications? Select all that apply.
| Options | DKA | HHS |
|---|---|---|
| Hypotension | ||
| Respiratory alkalosis | ||
| Septic shock | ||
| Cardiac arrhythmias | ||
| Renal failure | ||
| Cerebral edema |
Correct Answer: A,D,E,F
Rationale: Hypotension, arrhythmias (from hyperkalemia), renal failure (from dehydration), and cerebral edema are DKA risks.
Extract:
History and Physical
1000:
Client reports after eating breakfast this morning at 0630 that they began feeling tightness in chest that radiates to left arm. History:
Hyperlipidemia, hypertension, type 2 diabetes mellitus. Non-smoker. Denies use of alcohol or recreational drug use.
Nurses' Notes
1000:
Client reports tightness in chest that radiates to left arm. States pain as 7 on a scale of 0 to 10. Started to feel nauseous after breakfast. Client states, "I had scrambled eggs and bacon like I do every morning." Client is diaphoretic and short of breath. Heart rate irregular and tachycardic. Alert and oriented to person, place, and time. Lungs clear to auscultation in all lobes. Bowel sounds are present in all 4 quadrants. +1 pedal pulses. Skin is cool to touch. Capillary refill less than 2 seconds.
Vital Signs
1000:
• Temperature 37.1° C (98.8° F)
• Heart rate 110/min and irregular
• Respiratory rate 24/min
• Blood pressure 164/80 mm Hg
• Oxygen saturation 93% on room air
Diagnostic Results
1000:
• Myoglobin 100 mcg/L (less than 90 mcg/L)
• Creatine kinase 180 units/L (55 to 170 units/L)
• Troponin T 0.40 ng/mL (less than 0.1 ng/mL)
• Troponin 10.35 ng/mL (less than 0.03 ng/mL)
• Cholesterol 244 mg/dL (less than 200 mg/dL)
• Triglycerides 180 mg/dL (40 to 160 mg/dL)
• LDL cholesterol 148 mg/dL (less than 130 mg/dL)
• HDL cholesterol 42 mg/dL (greater than 45 mg/dL)
• C-reactive protein 2 mg/mL (less than 1.0 mg/mL)
• Blood glucose 103 mg/dL (74 to 106 mg/dL)
12-lead electrocardiogram: tachycardia with ST segment elevation and T wave changes
Chest x-ray: lungs are clear in all lobes
Provider prescriptions
1020:
• Nitroglycerin 0.5 mg SL may repeat every 5 min up to 3 doses as needed for chest pain
• Aspirin 160 mg PO daily
• Morphine 6 mg IV bolus every 3 hr PRN pain
• Metoprolol 25 mg PO every 6 hr x 48 hr, then metoprolol 100 mg PO twice daily
• Initiate peripheral IV site
• 0.9% sodium chloride 50 mL/hr by continuous IV infusion
• Oxygen at 2 L/min via nasal cannula if oxygen saturation is less than 90%
• Schedule stat echocardiogram
• 2 g sodium diet
Question 4 of 5
The nurse is reviewing the client's medical record. Which of the following findings indicates the client's condition has improved? Select all that apply.
Correct Answer: A,B,C,D,E
Rationale: Decreased pain, normalized vital signs (respiratory rate, heart rate, blood pressure), and improved oxygenation indicate recovery.
Extract:
Question 5 of 5
A nurse is caring for a client who has a contusion of the brainstem and reports thirst. The client's urinary output was 4,000 mL over the past 24 hr. The nurse should anticipate a prescription for which of the following IV medications?
Correct Answer: A
Rationale: Excessive thirst and high urine output suggest diabetes insipidus, treated with desmopressin to replace antidiuretic hormone.