ATI RN
ATI RN Adult Medical Surgical 2023 III Questions
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 1 of 5
For each assessment finding, click to specify if the assessment finding is consistent with diabetic ketoacidosis (DKA) or hyperglycemic-hyperosmolar state (HHS).
| Options | DKA | HHS |
|---|---|---|
| Urine ketones | ||
| Creatinine greater than expected reference range | ||
| Blood glucose greater than expected reference range | ||
| Skin turgor | ||
| Blood pH greater than expected reference range |
Correct Answer: (See rationale)
Rationale: Urine ketones and low pH are specific to DKA; high glucose and poor skin turgor apply to both; high creatinine is more common in HHS.
Question 2 of 5
The nurse understands that the client is at risk of developing which of the following complications? Select all that apply.
Correct Answer: A,C,D,E
Rationale: DKA increases risks for cerebral edema, arrhythmias, renal failure, and hypotension due to dehydration and electrolyte imbalances.
Extract:
Diagnostic Results
Day of Admission:
Brain Natriuretic Peptide (BNP): 450 pg/mL (Normal: <100 pg/mL)
Potassium: 4.8 mEq/L (Normal: 3.5-5 mEq/L)
Sodium: 132 mEq/L (Normal: 136-145 mEq/L)
BUN: 10 mg/dL (Normal: 10-20 mg/dL)
Day 2 of Hospitalization:
Brain Natriuretic Peptide (BNP): 110 pg/mL (Normal: <100 pg/mL)
Potassium: 3.3 mEq/L (Normal: 3.5-5 mEq/L)
Sodium: 135 mEq/L (Normal: 136-145 mEq/L)
BUN: 20 mg/dL (Normal: 10-20 mg/dL)
Medical Administration Record
Day of Admission:
• Medication: Furosemide 80 mg IV, 3 times per day
Vital Signs
Day of Admission:
Temperature: 36.6°C (97.8°F)
Heart Rate: 112/min
Respiratory Rate: 24/min
Blood Pressure: 186/84 mmHg
Oxygen Saturation: 93% on room air
Weight: 97.5 kg (215 lb)
Day 2 of Hospitalization:
Temperature: 36.6°C (97.8°F)
Heart Rate: 78/min
Respiratory Rate: 18/min
Blood Pressure: 102/78 mmHg
Oxygen Saturation: 98% on 2 L/min oxygen via nasal cannula
Weight: 90.7 kg (200 lb)
Question 3 of 5
The client is at risk for developing……. and……...
Correct Answer: B,D
Rationale: Heart failure increases the risk of fluid volume deficit and dysrhythmias due to cardiac strain and electrolyte imbalances.
Extract:
Medical History
Conditions:
• Dehydration
• Hyperlipidemia
• Hypertension
• Coronary artery disease (CAD)
Diagnostic Results
• WBC Count: 14,000/mm³ (Normal: 5,000 to 10,000/mm³)
• Hemoglobin (Hgb): 14 g/dL (Normal: 12 to 16 g/dL)
• Hematocrit (Hct): 40% (Normal: 34 to 47%)
• Sodium: 132 mEq/L (Normal: 136 to 146 mEq/L)
• Potassium: 6.2 mEq/L (Normal: 3.5 to 5 mEq/L)
• Calcium: 10 mg/dL (Normal: 9 to 10.5 mg/dL)
• BUN: 20 mg/dL (Normal: 10 to 20 mg/dL)
• Albumin: 2.8 g/dL (Normal: 3.5 to 5 g/dL)
• Fasting Blood Glucose: 140 mg/dL (Normal: 74 to 106 mg/dL)
• Triglycerides: 134 mg/dL (Normal: 34 to 160 mg/dL)
Nurses' Notes
Client is lying in bed. Awake, alert, and oriented to time, place, and person. Client is febrile and reports weakness. Receiving TPN via central line in left antecubital. Client is NPO and has had diarrhea x3 in past 4 hr. Crackles auscultated in posterior lobes.
Client has a productive cough and sputum is yellow in color. Client receiving 2 L/min oxygen via nasal cannula with an oxygen saturation of 90%. Abdomen is distended and tender. Active range of motion to all extremities. Denies pain at this time.
Question 4 of 5
Which of the following actions should the nurse take? For each potential nursing intervention, click to specify if the potential intervention is anticipated, nonessential, or contraindicated for the client.
| Options | Anticipated | Nonessential | Contraindicated |
|---|---|---|---|
| Obtain client weight twice daily. | |||
| Have 3 nurses verify the TPN solution prescription. | |||
| Request a prescription for insulin. | |||
| Request an antibiotic to be administered. | |||
| Decrease the client's oxygen to 1.5 L/min oxygen via nasal cannula. | |||
| Notify provider to increase TPN rate/hr. |
Correct Answer: (See rationale)
Rationale: Weight monitoring and insulin are anticipated for CAD and dehydration; TPN verification is nonessential; antibiotics and oxygen reduction are contraindicated without indication.
Extract:
Medical History
HIV
Diagnostic Results
On Diagnosis:
Total WBC: 6,000/mm³ (Normal: 5,000 to 10,000/mm³)
Platelet Count: 154,000/mm³ (Normal: 150,000 to 400,000/mm³)
Sodium: 139 mEq/L (Normal: 136 to 145 mEq/L)
Potassium: 4.2 mEq/L (Normal: 3.5 to 5 mEq/L)
BUN: 16 mg/dL (Normal: 10 to 20 mg/dL)
3 Month Visit:
Total WBC: 5,500/mm³ (Normal: 5,000 to 10,000/mm³)
Platelet Count: 112,000/mm³ (Normal: 150,000 to 400,000/mm³)
Sodium: 136 mEq/L (Normal: 136 to 145 mEq/L)
Potassium: 3.8 mEq/L (Normal: 3.5 to 5 mEq/L)
BUN: 18 mg/dL (Normal: 10 to 20 mg/dL)
Question 5 of 5
The client is at risk for developing……. due to.....
Correct Answer: A,G
Rationale: Low platelet count in HIV increases bleeding risk due to impaired clotting.