ATI RN
ATI Nur258 Med Surg 2 Final Exam Questions
Extract:
Question 1 of 5
A nurse is preparing dietary instructions for a client who has episodes of biliary colic from chronic cholecystitis. Which of the following responses from the client shows understanding of the teaching plan?
Correct Answer: D
Rationale: Avoiding foods high in fat, such as fried chicken, is important for managing biliary colic and chronic cholecystitis. Fatty foods can stimulate gallbladder contractions and exacerbate symptoms.
Question 2 of 5
A nurse is caring for a client who has a T4 spinal cord injury. Which of the following client findings should the nurse identify as an indication the client is at risk for experiencing autonomic dysreflexia?
Correct Answer: B
Rationale: Bladder distension is a common trigger for autonomic dysreflexia, a condition that occurs in individuals with spinal cord injuries at or above the T6 level, due to the excessive autonomic response to noxious stimuli such as a full bladder.
Question 3 of 5
A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and a sodium level of 123 mEq/L (nl. 135-145 mEq/L). Which of the following prescriptions should the nurse anticipate?
Correct Answer: C
Rationale: Restricting fluid intake is a key management strategy for SIADH to address the fluid overload and help correct the low sodium levels. This action directly targets the root cause of the hyponatremia by reducing fluid intake.
Extract:
Nurses Notes
Day 3 of hospitalization:
0730
Fingerstick blood glucose, fasting 114 mg/dL (nl. 60 to 110 mg/dL)
NPH insulin 40 units subcutaneous administered into abdomen as prescribed
0830:
Client reports nausea with emesis; vomited morning meal
1130:
Client reports feeling shaky, hungry, skin cool and diaphoretic Fingerstick blood glucose 55 mg/dL (nl. 60 to 110 mg/dL)
Vital Signs
Day 3 of hospitalization:
0700:
Temperature 37.3 °C (99.1 °F)
Blood pressure 118/62 mm Hg
Heart rate 84/min
Respiratory rate 20/min
SpO2 97% on room air
1130:
Temperature 37.8 °C (100 °F)
Blood pressure 104/56 mm Hg
Heart rate 118/min
Respiratory rate 20/min
SpO2, 95% on room air
Diagnostic Results
Day 3 of hospitalization:
HbA1c: 8.01% (nl. 4.4-6,4% )
Question 4 of 5
Select the 3 findings that require immediate follow-up.
Correct Answer: A,B,D
Rationale: Hypoglycemia (glucose 55 mg/dL), shakiness, and elevated heart rate require immediate follow-up to manage low blood sugar and assess underlying causes.
Extract:
Question 5 of 5
A nurse is caring for a client who has been exposed to anthrax. Which of the following interventions should the nurse plan to use while caring for this client?
Correct Answer: D
Rationale: Assessing the respiratory system is crucial for clients exposed to anthrax, particularly inhalation anthrax, as it can cause severe respiratory symptoms and complications. Prompt assessment is essential for early detection and treatment of respiratory distress.