ATI RN
ATI RN Adult Medical Surgical 2023 V Questions
Extract:
History and Physical
1000:
Client reports after eating breakfast this morning at 0630 that they began feeling tightness in chest that radiates to left arm. History:
Hyperlipidemia, hypertension, type 2 diabetes mellitus. Non-smoker. Denies use of alcohol or recreational drug use.
Nurses' Notes
1000:
Client reports tightness in chest that radiates to left arm. States pain as 7 on a scale of 0 to 10. Started to feel nauseous after breakfast. Client states, "I had scrambled eggs and bacon like I do every morning." Client is diaphoretic and short of breath. Heart rate irregular and tachycardic. Alert and oriented to person, place, and time. Lungs clear to auscultation in all lobes. Bowel sounds are present in all 4 quadrants. +1 pedal pulses. Skin is cool to touch. Capillary refill less than 2 seconds.
Vital Signs
1000:
• Temperature 37.1° C (98.8° F)
• Heart rate 110/min and irregular
• Respiratory rate 24/min
• Blood pressure 164/80 mm Hg
• Oxygen saturation 93% on room air
Diagnostic Results
1000:
• Myoglobin 100 mcg/L (less than 90 mcg/L)
• Creatine kinase 180 units/L (55 to 170 units/L)
• Troponin T 0.40 ng/mL (less than 0.1 ng/mL)
• Troponin 10.35 ng/mL (less than 0.03 ng/mL)
• Cholesterol 244 mg/dL (less than 200 mg/dL)
• Triglycerides 180 mg/dL (40 to 160 mg/dL)
• LDL cholesterol 148 mg/dL (less than 130 mg/dL)
• HDL cholesterol 42 mg/dL (greater than 45 mg/dL)
• C-reactive protein 2 mg/mL (less than 1.0 mg/mL)
• Blood glucose 103 mg/dL (74 to 106 mg/dL)
12-lead electrocardiogram: tachycardia with ST segment elevation and T wave changes
Chest x-ray: lungs are clear in all lobes
Provider prescriptions
1020:
• Nitroglycerin 0.5 mg SL may repeat every 5 min up to 3 doses as needed for chest pain
• Aspirin 160 mg PO daily
• Morphine 6 mg IV bolus every 3 hr PRN pain
• Metoprolol 25 mg PO every 6 hr x 48 hr, then metoprolol 100 mg PO twice daily
• Initiate peripheral IV site
• 0.9% sodium chloride 50 mL/hr by continuous IV infusion
• Oxygen at 2 L/min via nasal cannula if oxygen saturation is less than 90%
• Schedule stat echocardiogram
• 2 g sodium diet
Question 1 of 5
The nurse is reviewing the client's medical record. Which of the following findings indicates the client's condition has improved? Select all that apply.
Correct Answer: A,B,C,D,E
Rationale: Decreased pain, normalized vital signs (respiratory rate, heart rate, blood pressure), and improved oxygenation indicate recovery.
Extract:
Question 2 of 5
A nurse is administering furosemide 80 mg PO twice daily to a client who has pulmonary edema. Which of the following assessment findings indicates to the nurse that the medication is effective?
Correct Answer: C
Rationale: Weight loss indicates fluid loss, showing furosemide's effectiveness in reducing pulmonary edema.
Extract:
Nurses' Notes
0900:
Client came to the emergency department this morning and reports not feeling well for the last 12 hr and increasing blood glucose. Client has a history of type 1 diabetes mellitus and hypertension. Client weight is 88 kg (194 lb). The client was recently treated for bronchitis and pneumonia. Client reports nausea and decreased appetite.
Client is alert and orientated x 4, heart and lung sounds are clear. Client states that they have been frequently urinating and are extremely thirsty. Bowel sounds are hyperactive in all 4 quadrants. Bilateral pedal pulses 1+ Slight tenting of skin. Peripheral IV established and labs drawn.
1400:
Client admitted to the medical-surgical unit at 1200 today. Alert and orientated x4, heart and lung sounds clear. Client urinating 100 mL/hour. Client is tolerating soft diet and oral fluids. Bowel sounds are hyperactive in all 4 quadrants. Bilateral pedal pulses 2+. Blood glucose 310 mg/dL (74 to 106 mg/dL)
Vital Signs
0900:
• 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:
• Temperature 36.8° C (98.2" F) Pulse rate 84/min
• Respiratory rate 16/min
• Blood pressure 106/76 mm Hg
• Oxygen saturation 96% on room air
Laboratory Results
0915:
• Blood glucose 468 mg/dL (74 to 106 mg/dL)
• pH 7.30 (7.35 to 7.45)
• Potassium 5.5 mEq/L (3.5 to 5 mEq/L) S
• odium 138 mEq/L (136 to 145 mEq/L)
• Chloride 101 mEq/L (98 to 106 mEq/L)
• BUN 21 mg/dL (10 to 20 mg/dL)
• Creatinine 1.7 mg/dL (0.5 to 1.1 mg/dL)
• Urine dipstick positive for ketones (negative)
Provider Prescriptions
0930:
• Administer 0.9% sodium chloride at 15 ml/kg/hr for 1 hr and then reduce to 10 ml/kg/hr.
• Potassium chloride 20 mEq/L intravenous PRN potassium less than 5.0 mEq/L
• Regular insulin continuous infusion, titrate per DKA protocol once potassium is greater than 3.3 mEq/L.
• ondansetron 4mg intravenous bolus every 4 hr PRN nausea
• Acetaminophen 650 mg every 4 hr. PRN pain
• Magnesium sulfate 2 g intravenously over 2 hr for hypomagnesemia
• Strict I & O
• Blood glucose level hourly
• Initiate cardiac monitoring
Question 3 of 5
A nurse is caring for a client in the emergency department. Select the findings that indicate that the client's condition is improving.
Correct Answer: C,D,E
Rationale: Improved pulses, lower pulse rate, higher blood pressure, and reduced glucose indicate DKA resolution.
Extract:
Question 4 of 5
A nurse is caring for a client who has a spinal cord injury and has developed autonomic dysreflexia. Identify the sequence of steps the nurse should take.
Correct Answer: B,D,C,A
Rationale: Upright positioning reduces blood pressure, checking the bladder addresses a common trigger, antihypertensives treat severe hypertension, and documentation follows.
Extract:
Medical History
• Type 2 diabetes mellitus
• Hypertension, controlled by diuretic and ace-inhibitor therapy Osteoarthritis
Medication Administration Record
• Home medications:
• Metformin 1,000 mg PO BID
• Lisinopril 20 mg PO daily
• Celecoxib 100 mg PO BID
Diagnostic Results
Preoperative laboratory results: Basic Metabolic Profile (BMP):
• Glucose 190 mg/dL (74 to 106 mg/dL)
• BUN 16 mg/dL (10 to 20 mg/dL)
• Creatinine 0.8 mg/dL (0.5 to 1 mg/dL)
• Hemoglobin A1C 9.5% (Poor diabetic control: greater than 99%)
Current laboratory results:
Basic Metabolic Profile (BMP):
• Glucose 280 mg/dl (74 to 106 mg/dl)
• BUN 15 mg/dL (10 to 20 mg/dL)
• Creatinine 0.7 mg/dL (0.5 to 1 mg/dl)
Vital Signs
Preoperative:
• Temperature 36.4° C (97.6° F)
• Heart rate 82/min
• Respiratory rate 20/min
• Blood pressure 126/74 mm Hg
• Oxygen saturation 95% on room air
Current:
• Temperature 37 2 C (99° F)
• Heart rate 92/min
• Respiratory rate 22/min
• Blood pressure 136/85 mm Hg
• Oxygen saturation 98% on 2 L/min nasal cannula
Question 5 of 5
A nurse is caring for a client who is postoperative following a total knee arthroplasty. Complete the following sentence by using the lists of options. The client in a higher pick for..... as evidenced by the client's......
Correct Answer: A,F
Rationale: Elevated blood glucose (280 mg/dL) increases infection risk post-surgery, as hyperglycemia impairs wound healing and immune response.