ATI RN
ATI RN Adult Medical Surgical 2023 III Questions
Extract:
Question 1 of 5
A nurse is providing discharge teaching for a client who is receiving treatment for genital herpes. Which of the following statements by the client indicates effectiveness of the teaching?
Correct Answer: C
Rationale: Genital herpes lesions typically resolve within 2-6 weeks with antiviral treatment, indicating understanding.
Question 2 of 5
A nurse is caring for a client in the ICU. The client's ECG monitor tracing reveals sinus bradycardia and ST segment elevation. The client reports shortness of breath and feeling dizzy and faint. Which of the following medications should the nurse administer?
Correct Answer: C
Rationale: Atropine treats symptomatic bradycardia, addressing the client's low heart rate and related symptoms.
Extract:
History and Physical
Presenting Complaint:
Time of Onset: 0630 hours
Symptoms: Client reports tightness in chest that radiates to left arm after eating breakfast. The pain was initially rated as 7/10 and reduced to 5/10 after treatment with nitroglycerin. Client also experienced nausea, diaphoresis, and shortness of breath. Heart rate was irregular and tachycardic.
Medical History:
Conditions: Hyperlipidemia, hypertension, type 2 diabetes mellitus.
Lifestyle: Non-smoker. Denies use of alcohol or recreational drugs.
Nurses' Notes
1000 Hours:
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.
1200 Hours:
Client states chest pain is now a 5 on a scale of 0 to 10 after 2 doses of nitroglycerin. Breathing easier with oxygen applied at 2 L/min via nasal cannula.
Vital Signs
1000 Hours:
Temperature: 37.1°C (98.8°F)
Heart Rate: 110/min, irregular
Respiratory Rate: 24/min
Blood Pressure: 164/80 mm Hg
Oxygen Saturation: 93% on room air
1015 Hours:
Temperature: 36.7°C (98.2°F)
Heart Rate: 120/min, irregular
Respiratory Rate: 22/min
Blood Pressure: 176/82 mm Hg
Oxygen Saturation: 89% on room air
1200 Hours:
Temperature: 36.7°C (98.2°F)
Heart Rate: 100/min, irregular
Respiratory Rate: 22/min
Blood Pressure: 110/62 mm Hg
Oxygen Saturation: 92% on 2 L/min via nasal cannula
Intake/Output:
Intake: 500 mL
Output: 32 mL
Diagnostic Results
Myoglobin: 100 mcg/L (Normal: <90 mcg/L)
Creatine Kinase: 180 units/L (Normal: 55-170 units/L)
Troponin T: 0.40 ng/mL (Normal: <0.1 ng/mL)
Troponin I: 0.35 ng/mL (Normal: <0.03 ng/mL)
Cholesterol: 244 mg/dL (Normal: <200 mg/dL)
Triglycerides: 180 mg/dL (Normal: 40-160 mg/dL)
LDL Cholesterol: 148 mg/dL (Normal: <130 mg/dL)
HDL Cholesterol: 42 mg/dL (Normal: >45 mg/dL)
C-reactive Protein: 2 mg/mL (Normal: <1.0 mg/mL)
Blood Glucose: 103 mg/dL (Normal: 74-106 mg/dL)
12-Lead ECG: Tachycardia with ST segment elevation and T wave changes
Chest X-ray: Lungs clear in all lobes
Provider's Prescriptions
Nitroglycerin: 0.4 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 100 mg PO twice daily
Peripheral IV Site: Initiated
IV Fluids: 0.9% sodium chloride at 50 mL/hr continuous infusion
Oxygen: 2 L/min via nasal cannula if O2 saturation < 90%
Question 3 of 5
Select the findings below that would indicate that the client has a potential problem.
Correct Answer: A,C,D,F
Rationale: Chest pain, nausea, diaphoresis, and irregular tachycardia are signs of a potential cardiac event requiring intervention.
Extract:
Question 4 of 5
A nurse is caring for a client who has oral achalasia. The nurse should ask the client which of the following questions to assess their ability to swallow?
Correct Answer: B
Rationale: Achalasia causes difficulty in esophageal emptying, often leading to a sensation of food being stuck at the base of the throat.
Extract:
Patient Summary
Presenting Complaint:
Time of Arrival: 0900 hours
Symptoms: Client reports not feeling well for the past 12 hours, with increasing blood glucose levels. Client has a history of type 1 diabetes mellitus and hypertension. Recent treatment for bronchitis and pneumonia. Reports nausea, decreased appetite, frequent urination, and extreme thirst.
Medical History:
Conditions: Type 1 diabetes mellitus, hypertension.
Recent Illnesses: Bronchitis, pneumonia.
Nurses' Notes
0900 Hours:
Client presents with a history of type 1 diabetes mellitus and hypertension. The client is alert and oriented x4. Heart and lung sounds are clear. The client reports frequent urination, extreme thirst, nausea, and decreased appetite. Bowel sounds are hyperactive in all 4 quadrants. Bilateral pedal pulses are 1+. Slight tenting of skin noted. Peripheral IV established, and labs drawn.
Vital Signs
0900 Hours:
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
1400 Hours:
Temperature: 36.8°C (98.2°F)
Pulse Rate: 84/min
Respiratory Rate: 16/min
Blood Pressure: 106/76 mm Hg
Laboratory Results
0915 Hours:
Blood Glucose: 468 mg/dL (Normal: 74-106 mg/dL)
pH: 7.30 (Normal: 7.35-7.45)
Potassium: 5.5 mEq/L (Normal: 3.5-5.0 mEq/L)
Sodium: 138 mEq/L (Normal: 136-145 mEq/L)
Chloride: 101 mEq/L (Normal: 98-106 mEq/L)
BUN: 21 mg/dL (Normal: 10-20 mg/dL)
Creatinine: 1.7 mg/dL (Normal: 0.5-1.1 mg/dL)
Urine Dipstick: Positive for ketones (Normal: Negative)
Provider's Prescriptions
Fluids: Administer 0.9% sodium chloride at 15 ml/kg/hr for 1 hr, then reduce to 10 ml/kg/hr.
Potassium: Potassium chloride 20 mEq/L IV PRN if potassium is less than 5.0 mEq/L.
Insulin: Regular insulin continuous infusion, titrate per DKA protocol once potassium is greater than 3.3 mEq/L.
Anti-nausea: Ondansetron 4 mg IV bolus every 4 hr PRN for nausea.
Pain Relief: Acetaminophen 650 mg every 4 hr PRN for pain.
Magnesium: Magnesium sulfate 2 g IV over 2 hr for hypomagnesemia.
Monitoring: Strict intake and output, blood glucose level hourly.
Question 5 of 5
Select the findings that indicate that the client's condition is improving.
Correct Answer: A, B, D
Rationale: