ATI RN
ATI Med Surg Pharm Comprehensive Exam 1 Questions
Extract:
Question 1 of 5
A nurse is teaching a client who reports taking gingko biloba to improve his memory. Which of the following adverse effects should the nurse include?
Correct Answer: D
Rationale: Bleeding gums can occur because gingko biloba has blood-thinning properties and can increase the risk of bleeding.
Question 2 of 5
A nurse is caring for a client who is receiving total parenteral nutrition via a peripherally inserted central catheter (PICC). When assessing the client, the nurse notes swelling of the client's arm above the PICC insertion site. Which of the following actions should the nurse take first?
Correct Answer: D
Rationale: Measuring the circumference of both upper arms is the first action to assess the extent of the swelling and compare it to the other arm, which will help determine the severity of the issue.
Question 3 of 5
A nurse is caring for a client who has metastatic bone cancer. The client states, 'I want to go home to die.' The family is concerned about meeting the client's care needs at home. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: Discussing initiating hospice care is appropriate to address the client's desire to go home for end-of-life care and to provide support and resources for the family.
Question 4 of 5
A nurse using the principle-based approach to client care seeks to avoid causing harm to clients in all situations. What is this principle known as?
Correct Answer: C
Rationale: Nonmaleficence is a core principle in healthcare ethics and emphasizes the primary duty of healthcare providers to do no harm to their clients.
Extract:
Nurses Notes
Hospital Day 1
1700:
Client admitted to the medical surgical unit for reports of right leg swelling and pain. Area of redness and swelling noted to right thigh with small white pustule in center. Area is warm and tender to touch. Area marked with an indelible marker. Morphine and first dose of cefuroxime administered in the emergency department. Client resting comfortably.
0800:
Client alert and oriented to person, place, and time. Reports right leg pain interrupted sleeping: rates pain as 8on 0 to 10 scale. Lungs clear bilaterally, respirations unlabored. Heart rhythm regular. Abdomen soft and non-distended, bowel sounds present all 4 quadrants.
Vital Signs
0800:
Temperature 37.1 °C (98.8 °F)
Heart rate 48/min
Respiratory rate 14/min
Blood pressure 122/84 mm Hg
0815:
Heart rate 42/min
Respiratory rate 10/min
Blood pressure 108/62 mm Hg
Medication Administration Record
Provider Prescriptions
Admission: Cefuroxime 250 mg po q12h (0800, 1600)
Lovastatin 20 mg po qd with dinner (1800)
Pantoprazole 40 mg po qd (0800)
Morphine 30 mg po q4h prn for pain
Propranolol 40 mg po bid, hold for apical pulse < 50/min (0800, 1600)
Question 5 of 5
The nurse reviews the medication administration record following the 0815 assessment findings. Which of the following administered medications would require an incident report?
Correct Answer: A
Rationale: Propranolol is a beta-blocker used to control blood pressure and heart rate. However, the nurse has a hold order for propranolol if the apical pulse (heart rate) is less than 50 beats per minute. The nurse documented a heart rate of 42 bpm at 0815, which falls below the hold parameter for propranolol. Administering propranolol in this case could worsen the client's bradycardia (slow heart rate) and therefore requires an incident report.