ATI RN
ATI N120n122 Med Surg Exam Questions
Extract:
Question 1 of 5
A nurse is providing teaching to a client who has vitamin B12 deficiency. Which of the following foods should the nurse instruct the client to consume? Select all that apply.
Correct Answer: B,E,F
Rationale: Eggs, beef, and milk are good sources of vitamin B12 and should be included in the diet of someone with a deficiency. Bananas, spinach, carrots, and quinoa are not significant sources of vitamin B12.
Question 2 of 5
The client with sickle cell disease (SCD) has recently been sick and is now experiencing a vaso-occlusive crisis. Which priority interventions should the nurse implement?
Correct Answer: D
Rationale: Maintaining IV fluids, administering pain medications, and providing supplemental oxygen are critical interventions that address the acute needs of the client in crisis, aiming to alleviate pain and improve oxygenation. Encouraging frequent ambulation is not appropriate during a vaso-occlusive crisis, as it can exacerbate pain and further compromise blood flow. While monitoring the RBC count is important, it is not the most immediate intervention during a crisis. Treating the client in an outpatient setting is inappropriate during a vaso-occlusive crisis, which typically requires inpatient care for effective pain management and hydration.
Question 3 of 5
A nurse is caring for a client who has chronic renal disease and is taking epoetin alfa (Procrit). Which laboratory result would be used to assess the effectiveness of this medication?
Correct Answer: A
Rationale: Red blood cells (RB
C) and hemoglobin (Hg) levels are directly affected by epoetin alfa, which stimulates red blood cell production in the bone marrow, making these values essential for assessing the medication's effectiveness. The leukocyte count (WB
C) is not relevant to the effects of epoetin alfa, as this medication primarily influences erythropoiesis. The erythrocyte sedimentation rate (ESR) is a non-specific test used to detect inflammation but does not provide information regarding the effectiveness of epoetin alfa. The thrombocyte count does not assess the effectiveness of epoetin alfa.
Question 4 of 5
A nurse is preparing to transfuse a unit of packed red blood cells for a client with severe anemia. The nurse should identify that which of the following interventions will help prevent an acute hemolytic reaction?
Correct Answer: A
Rationale: Ensuring the blood is compatible with the client's blood type is critical in preventing an acute hemolytic reaction, as incompatible blood transfusions can cause serious, potentially life-threatening reactions. Administering the transfusion rapidly can increase the risk of complications and does not prevent hemolytic reactions; transfusions should be given at a safe rate based on the client's condition. Using a blood warmer is not a standard intervention to prevent hemolytic reactions; it's typically used in specific cases such as massive transfusions or hypothermia, but it does not address compatibility. Administering prophylactic antihistamines is not a recommended practice to prevent hemolytic reactions; it is more relevant for preventing allergic reactions associated with transfusions.
Question 5 of 5
A client with iron deficiency anemia is prescribed ferrous sulfate. Which instruction by the nurse is most appropriate to include in the client's teaching plan?
Correct Answer: C
Rationale: Stools becoming darker in color is a common and expected side effect of ferrous sulfate due to the presence of unabsorbed iron. It is important for clients to know this to avoid unnecessary alarm. Decreasing intake of foods high in fiber is not necessary; in fact, fiber can help prevent constipation, a common side effect of iron supplements. Vitamin C enhances the absorption of iron; thus, avoiding it is incorrect. Taking the medication on a full stomach may decrease absorption.