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 ensures nutritional adequacy, insulin corrects hyperglycemia, and antibiotics address infection signs (crackles, yellow sputum).
Extract:
Question 2 of 5
A nurse is caring for a client who is using a continuous passive motion (CPM) machine following a total knee arthroplasty. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: Turning off the CPM machine during eating prevents discomfort and ensures safety, allowing the client to focus on nutrition.
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 3 of 5
The nurse is reviewing the client's medical record. For each potential provider's prescription, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the client.
| Options | Anticipated | Nonessential | Contraindicated |
|---|---|---|---|
| Metoprolol 5 mg every 2 to 3 min up to three doses | |||
| Oxygen at 2 L/min via nasal cannula | |||
| Draw electrolytes along with Hgb and Hct | |||
| Morphine 6 mg IV bolus every 3 hr as needed for pain | |||
| Nitroglycerin 0.4 mg SL now may repeat every 5 min up to 3 doses | |||
| Obtain daily weight | |||
| Atropine 0.5 mg IV bolus every 5 min up to 2 mg |
Correct Answer: B,C,D,E,F
Rationale: Oxygen, labs, morphine, nitroglycerin, and weight monitoring support acute coronary syndrome management; metoprolol IV dosing and atropine are inappropriate.
Extract:
Question 4 of 5
A nurse is caring for a client who has a sealed radiation implant. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: Limiting visitor time reduces radiation exposure, a key safety measure for sealed implants.
Question 5 of 5
A nurse is assessing a client who has heart failure and a new prescription for metoprolol. Which of the following findings should the nurse identify as an adverse effect of the medication?
Correct Answer: A
Rationale: Metoprolol, a beta-blocker, can cause bradycardia (heart rate <60/min). A heart rate of 48/min is an adverse effect requiring monitoring or intervention.