ATI LPN
ATI LPN Med Surg Concept 2 Exam Questions
Extract:
History & Assessment
Medical/Surgical history: Type 1 diabetes mellitus x8 years. Uses an insulin pump and self-manages care. Has never been hospitalized for diabetes previously. Appendix removed at age 7 years. No other medical or surgical history.
Social History: Roommate says the patient drinks on the weekends only and does not use drugs or tobacco. Says she is a "hard-working college student."
Family History: Family lives out of state and includes married parents and a younger brother. No family medical history obtained.
Physical Assessment: Arousable but lethargic. PERRLA 3 mm: moves all extremities but does not follow commands. Mucous membranes dry, lips chapped, acetone breath. Lungs clear to auscultation: rapid and deep respiratory pattern. Tachycardic and hypotensive. Red, raised rash on lower extremities. Hypoactive bowel sounds.
Medications: Regular insulin via an insulin pump in the left medial abdomen. Pump found to be shut off.
Nurses' Notes
3/29/XX
1315
Patient brought to the emergency department by a college roommate. Recently traveled with friends to Mexico for spring break, returning 2 days ago. Roommate says that there was a lot of "partying." Over the last 24 hours, patient has experienced nausea and vomiting, has been sleeping a lot, and has developed blurred vision and headache.
3/29/XX
1325
Patient placed on a cardiac monitor for irregular pulse. Sinus tachycardia noted. Serum labs drawn and sent to the lab; 20-gauge peripheral IV inserted in left forearm and 20-gauge peripheral IV inserted in right forearm. NS initiated at 250 mL/hr.
3/29/XX
1430
Orders implemented. Receiving IV NS. IV insulin per titration. Urine output 50 mL/hr. Dark amber color. Continues to be lethargic
1035
DKÁ has resolved over the past 4 days. Alert and oriented. vital signs stable, Insulin being delivered via pump with stable blood glucose levels
Lab Results
3/29/XX
1315
Glucose 525 mg/dL. per glucometer 3/29/XX
1335
WBC: 12.2 103/mm3 (4.5-11.1 103/mm3)
RBC 3.5 million/mm3 (3.61-5.11 million/mm3) Platelets: 355.000/mm3 (150,000-450,000/mm3) BUN: 35 mg/dL (8-21 mg/dL)
Creatinine: 1.2 mg/dl (0.5-1.2 mg/dL)
Sodium: 145 mEq/L (135-145 mEq/L)
Potassium: 3.1 mEq/L (3.5-5.0 mEq/L)
Glucose: 530 mg/dL (65-99 mg/dL)
ATC: 6.9% (6.5% or lower) 3/29/XX
1430
Glucose 460 mg/dL per glucometer 1035
Glucose 89 mg/dL per glucometer
Vital Signs
3/29/XX
1320
Temp 100.2°F (37.8°C)
HR 115 bpm: irregular
RR 26 breaths/min; rapid, deep SpO2 98% on room air
BP 87/52 mm Hg 3/29/XX
1430
Temp 100.4°F (37.8°C)
HR 110 bpm: regular
RR 24 breaths/min: rapid, deep Sp02 98% on room air
BP 94/56 mm Hg
Question 1 of 5
The nurse recognizes the patient is demonstrating signs of diabetic ketoacidosis (DKA). Which findings support this recognition? Select all that apply.
Correct Answer: A,C,F,G
Rationale: A. Acetone breath, characterized by a fruity or acetone-like odor on the patient's breath, is a classic sign of DKA. In addition, Kussmaul respirations, which are deep and labored breathing patterns, can occur as the body attempts to compensate for metabolic acidosis in DKA. C. Nausea and vomiting are common symptoms of DKA and can occur due to metabolic acidosis, electrolyte imbalances, and gastrointestinal disturbances associated with the condition. F. Tachycardia and hypotension are signs of hemodynamic instability, which can occur in severe cases of DKA due to dehydration, electrolyte imbalances, and the systemic effects of metabolic acidosis. G. Turning off an insulin pump can lead to insulin deficiency, which is a precipitating factor for DKA, particularly in patients with type 1 diabetes who rely on continuous insulin therapy.
Extract:
Question 2 of 5
A nurse is reinforcing teaching about use of a metered-dose inhaler (MDI) with a client who has a new diagnosis of asthma. Identify the sequence the client should follow.
Correct Answer: A,B,C,D,E
Rationale: A. Shake the canister to ensure proper mixing. B. Create a tight seal around the mouthpiece. C. Inhale slowly while pressing the canister. D. Hold breath for 10 seconds for better absorption. E. Exhale slowly through pursed lips.
Question 3 of 5
A nurse is reviewing the medical record of a client who has a peptic ulcer. Which of the following findings should the nurse identify as a risk factor for this condition?
Correct Answer: B
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, are known to increase the risk of peptic ulcer formation by disrupting the protective mucosal barrier of the stomach and duodenum.
Question 4 of 5
Which client would the nurse identify as high risk for developing aspiration pneumonia?
Correct Answer: D
Rationale: Patients who have had a stroke are at high risk for aspiration pneumonia due to potential impairment of their swallowing mechanisms and decreased gag reflex.
Question 5 of 5
The nurse is reviewing the patient's record. Select to highlight the findings that demonstrate that the patient is improving.
Correct Answer: A,B,C,D
Rationale: HR: 110 bpm; regular - The heart rate has decreased from 115 bpm and is now regular, suggesting improved cardiac rhythm stability. RR: 24 breaths/min; rapid, deep - The respiratory rate has decreased from 26 breaths/min, indicating less rapid breathing. BP: 94/56 mm Hg - While the blood pressure remains relatively low, there is a slight improvement compared to the previous reading. Glucose 460 mg/dl - The glucose level has decreased from 525 mg/dL and 530 mg/dL in previous readings. While still elevated, this indicates some improvement in hyperglycemia.