ATI RN
ATI Advanced Med Surg Final Exam 0924 Questions
Extract:
Nurses' Notes
Day 1:
0900:
Client admitted from emergency department with hemoptysis, dull chest pain, increasing fatigue, anorexia, nausea, chest tightness, and 3.2 kg (7 lb) weight loss in 2 weeks. Heart rate regular, lung sounds with crackles in bilateral upper lobes. No edema. Airborne precautions initiated upon admission.
Day 2:
1100:
Client reports shortness of breath, nausea, and fatigue. Crackles auscultated bilaterally throughout lung fields. Productive cough, with thick, blood-streaked sputum. Bowel sounds active, no edema.
Day 3:
0900:
Client reports some improvement in dyspnea. Client coughing up thick, yellow, blood-streaked sputum. Crackles auscultated in bilateral upper lobes of lungs. Sclera noted to be yellow. Client’s weight is 0.7 kg (1.6 lb) less than at admission. Encouraged to increase intake of oral fluids. Client reports urine appears reddish orange in color.
Medical history
Client has no chronic illnesses. Traveled out of the country 2 months ago.
Vital Signs
Day 1:
Temperature 38.6°C (101.4°F)
Heart rate 96/min
Respiratory rate 26/min
Blood pressure 158/88 mm Hg
Oxygen saturation 91% on room air
Day 2:
Temperature 38.4°C (101.2°F)
Heart rate 88/min
Respiratory rate 24/min
Blood pressure 152/82 mm Hg
Oxygen saturation 92% on 02 at 4L/min via nasal cannula
Day 3:
Temperature 37.8°C (100.1°F)
Heart rate 82/min
Respiratory rate 22/min
Blood pressure 130/78 mm Hg
Oxygen saturation 96% on 02 at 4L/min via nasal cannula
Provider prescriptions
Day 1:
Purified protein derivative 0.1 mL intradermal to right forearm
Isoniazid 300 mg PO daily
Rifampin 600 mg PO daily
Acetaminophen 500 mg 1-2 tablets PO every 4 to 6 hr PRN fever, pain
Diagnostic Results
Day 1
ALT 36 SI/L (4-36 SI/L)
AST 35 units/L (0-35 units/L)
Alkaline phosphatase 118 units/L (30-120 units/L)
Chest x-ray caseation with inflammation throughout upper lobes
Day 3:
Mantoux Test: 12 mm induration (negative, reaction less than 5 mm) ALT 38 SI-36 SI/L)
AST 36 units/L (0-35 units/L)
Alkaline phosphatase 129 units/L (30-120 units/L)
Question 1 of 5
A nurse on a medical-surgical unit is caring for a newly admitted client with a diagnosis of R/O tuberculosis. Which of the following findings should the nurse report to the provider?
Correct Answer: A
Rationale: Yellow sclera indicates jaundice, which could be a sign of liver dysfunction, especially concerning given the client is on isoniazid and rifampin, which can cause hepatotoxicity.
Extract:
Question 2 of 5
A nurse is teaching a client who is receiving treatment for metastatic colorectal cancer about the adverse effects of bevacizumab. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication?
Correct Answer: A
Rationale: Nosebleeds (epistaxis) are a common adverse effect of bevacizumab, as it can cause bleeding due to its anti-angiogenic properties.
Question 3 of 5
A nurse is preparing to administer ticarcillin/clavulanate 3.1 g by intermittent IV bolus over 30 min. Available is ticarcillin/clavulanate 3.1 g in 50 ml 0.9% sodium chloride (NSS). The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
Correct Answer: B
Rationale: First, determine the total volume to be infused: 50 mL. Next, calculate the time in hours: 30 minutes is 0.5 hours. 50/0.5 = 100 mL/hr.
Extract:
Medical History
Client fell on ice 24 hr ago landing on left arm. Had pain after impact and states, "I thought I bruised it." Arm began Welling immediately after fall. The client applied ice and elevated the extremity at home. Self- administered ibuprofen for pain. Swelling continued throughout day and night with pain increasing
History: Osteoporosis that is managed with ibuprofen 600 mg PO three times daily
Compression fracture T11 and T12 4 years ago
Medications: Multivitamin PO daily. Alendronate 70 mg PO weekly
Nurses Notes
Client presents to the emergency department accompanied by their partner. Reports severe pain in left arm a hand. Rates pain as a 10 on a 0 to 10 pain scale. Pain increases with movement. Left forearm and hand edematous and skin is taut. Abrasions noted on left forearm and palm of left hand. Left hand and fingers pale and cool to touch with weak radial pulse noted. Right radial pulse strong. Left forearm ecchymotic. Client states, "The fingers on my left hand feel numb and tingly." Capillary refill greater than 5 seconds in left hand, right hand less than 3 seconds.
Vitals
BP: 132/84 mm Hg
Pulse rate: 86/min
Respirations: 18/min
Temperature: 37.4° C (99.3° F)
Oxygen saturation: 98% on room air
Question 4 of 5
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.
Correct Answer: B,D
Rationale: The symptoms indicate acute compartment syndrome. Preparing for a fasciotomy and requesting pain medication are critical actions. Monitoring neurovascular status and WBC count assesses progress and potential infection.
Extract:
Question 5 of 5
A nurse in the emergency department is caring for a client who sustained a head injury. The nurse notes the client's IV fluids are infusing at 125 mL/hr. Which of the following is an appropriate action by the nurse?
Correct Answer: D
Rationale: Continuing the rate at 125 mL/hr is appropriate for maintaining the current IV fluid regimen unless there are specific orders or conditions that require a change.