ATI RN
ATI Advanced Med Surg Final Exam 0924 Questions
Extract:
Medical History
75-year-old male who reports increased dyspnea x 4 days. Denies cough or fever.
Past medical history: Two pack a day smoker for 50 years. Diagnosed with lung cancer 4 years ago and treated. Over the last year has developed frequent pleural effusions treated with thoracentesis. Hypertension.
Surgical history: Right lower lobectomy 4 years ago. Left hernia repair 25 years ago.
Nurses' Notes:
1000:
Alert and oriented x3. Reports difficulty breathing.
Respirations 28/min and labored.
Oxygen saturation 91%
Crackles auscultated left lung base. Fremitus decreased left chest wall.
1200:
Thoracentesis performed by provider.
1,000 mL cloudy yellow fluid removed, labeled and sent to lab for testing.
Dressing applied to puncture site.
Respiratory rate 24/min and regular. Oxygen saturation 95%
Question 1 of 5
The nurse is caring for the client following a thoracentesis. (Select the 3 findings that require immediate follow-up.)
Correct Answer: A,B,D
Rationale: Decreased lung sounds, heart rate 110/min, and subcutaneous emphysema indicate potential complications like pneumothorax or procedure-related issues requiring immediate follow-up.
Extract:
Question 2 of 5
A nurse is reviewing the laboratory findings for a client who has idiopathic thrombocytopenic purpura (ITP). Which of the following findings should the nurse expect to be decreased?
Correct Answer: D
Rationale: Platelets are expected to be decreased in ITP, which is characterized by an immune-mediated destruction of platelets.
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 3 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 4 of 5
A nurse is caring for a client who has undergone a transurethral prostatectomy. Following catheter removal, the nurse should inform the client that he should expect which of the following variations in the color of his urine?
Correct Answer: B
Rationale: Pale pink urine is expected as some bleeding is normal following a transurethral prostatectomy.
Question 5 of 5
A male client reports to the on-call clinic nurse that he took tadalafil 10 mg by mouth two hours ago and his skin now feels flushed. He reports a history of stable angina but denies experiencing any current or recent chest pain. Which action should the nurse take?
Correct Answer: D
Rationale: Tadalafil commonly causes facial flushing as a side effect. Reassuring the client is appropriate since he is not experiencing chest pain or other concerning symptoms.