Questions 78

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ATI Advanced Med Surg Final Exam 0924 Questions

Extract:


Question 1 of 5

A nurse is planning care for a client following a cardiac catheterization accessed through his femoral artery. Which of the following actions should the nurse plan to take?

Correct Answer: B

Rationale: Performing neurovascular checks with vital signs is essential to monitor for complications such as bleeding, hematoma, or compromised circulation to the extremity.

Extract:

Vital Signs:
1500:
Temperature 37.3° C (99.1° F)
BP 154/64 mm Hg
Heart rate 105/min
Respiratory rate 26/min
Oxygen saturation 93% on room air

Medical History
Cirrhosis
Hypertension, controlled with metoprolol therapy
Type 2 diabetes mellitus, controlled with glipizide therapy
Physical Examination
1500:
Client presents with decreased level of consciousness, slurred speech, and impaired concentration. Client is lethargic, does not respond to questions or simple commands. Pupils round, reactive to light and accommodation. Partner states client has been sleeping during the day and remains awake at night.
Skin is dry and jaundiced with petechiae present to arms and legs.
S1 S2 heard on auscultation. +1 pulses on bilateral radial and pedal pulses. Peripheral edema +3 present in bilateral lower extremities.
Crackles auscultated in bilateral lower lobes.
Abdomen distended with ascites. Hypoactive bowel sounds present in all four quadrants. Partner reports no knowledge of rectal bleeding, states client has been tolerating diet with no nausea or vomiting.
Client placed in semi-Fowler's position at 45°, feet elevated. Bed in low position. Partner remains at client's bedside.
Diagnostic Results
1700:
Albumin 2.9 g/dL (3.5 to 5 g/dL)
Ammonia 250 mcg/dL (10 to 80 mcg/dL)
Sodium 138 mEq/L (136 to 145 mEq/L)
Potassium 4.8 mEq/L (3.5 to 5 mEq/L)
Fasting glucose 148 mg/dL (70 to 110 mg/dL)
BUN 18 mg/dL (10 to 20 mg/dL)
Creatinine 0.8 mg/dL (0.5 to 1 mg/dL)


Question 2 of 5

The client is exhibiting manifestations of __ due to the client's __

Correct Answer: A

Rationale: The client is experiencing alterations in their level of consciousness and has an elevated ammonia level, indicative of encephalopathy due to liver failure from cirrhosis.

Extract:


Question 3 of 5

A nurse is caring for a client who is postoperative following an open reduction and internal fixation of a fractured femur. Which of the following actions is the most important for the nurse to complete in the postoperative period?

Correct Answer: B

Rationale: Performing neurovascular checks of the extremities is the most important action to identify complications such as compartment syndrome or impaired circulation.

Question 4 of 5

A nurse is reviewing the medication history of a client who has a new prescription for colchicine. Which of the following medications increases the client's risk when used in combination with colchicine for developing rhabdomyolysis?

Correct Answer: D

Rationale: Atorvastatin increases the risk of rhabdomyolysis when used with colchicine, as both can contribute to muscle damage.

Question 5 of 5

A nurse is assessing a client who has diabetes insipidus. Which of the following findings is a manifestation of this diagnosis?

Correct Answer: B

Rationale: Tachycardia can occur in diabetes insipidus due to dehydration and fluid loss.

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