ATI RN
ATI Med Surg Pharm Comprehensive Exam 1 Questions
Extract:
Nurses Notes
Hospital Day 1
1700:
Client admitted to the medical surgical unit for reports of right leg swelling and pain. Area of redness and swelling noted to right thigh with small white pustule in center. Area is warm and tender to touch. Area marked with an indelible marker. Morphine and first dose of cefuroxime administered in the emergency department. Client resting comfortably.
0800:
Client alert and oriented to person, place, and time. Reports right leg pain interrupted sleeping: rates pain as 8on 0 to 10 scale. Lungs clear bilaterally, respirations unlabored. Heart rhythm regular. Abdomen soft and non-distended, bowel sounds present all 4 quadrants.
Vital Signs
0800:
Temperature 37.1 °C (98.8 °F)
Heart rate 48/min
Respiratory rate 14/min
Blood pressure 122/84 mm Hg
0815:
Heart rate 42/min
Respiratory rate 10/min
Blood pressure 108/62 mm Hg
Medication Administration Record
Provider Prescriptions
Admission: Cefuroxime 250 mg po q12h (0800, 1600)
Lovastatin 20 mg po qd with dinner (1800)
Pantoprazole 40 mg po qd (0800)
Morphine 30 mg po q4h prn for pain
Propranolol 40 mg po bid, hold for apical pulse < 50/min (0800, 1600)
Question 1 of 5
The nurse reviews the medication administration record following the 0815 assessment findings. Which of the following administered medications would require an incident report?
Correct Answer: A
Rationale: Propranolol is a beta-blocker used to control blood pressure and heart rate. However, the nurse has a hold order for propranolol if the apical pulse (heart rate) is less than 50 beats per minute. The nurse documented a heart rate of 42 bpm at 0815, which falls below the hold parameter for propranolol. Administering propranolol in this case could worsen the client's bradycardia (slow heart rate) and therefore requires an incident report.
Extract:
Question 2 of 5
A nurse is providing teaching to a client about interventions to reduce the risk of developing cardiovascular disease. Which of the following statements by the client should indicate to the nurse the need for further teaching?
Correct Answer: B
Rationale: Trans-fatty acids increase the risk of cardiovascular disease; this statement indicates a misunderstanding.
Question 3 of 5
A nurse plans to leave her scheduled shift an hour early without permission or notification of the charge nurse. The clients in the nurse's assignment are stable. Which of the following legal torts applies to this situation?
Correct Answer: A
Rationale: Negligence involves failing to provide care that a reasonably prudent nurse would provide, such as leaving a shift early without proper handoff or notification, which could compromise patient safety.
Extract:
Vital Signs
1200:
Temperature 38.6° C (10.5° F)
Heart rate 109/min
Respiratory rate 28/min
Blood pressure 106/54 mm Hg
Oxygen saturation 94% on room air
Nurses' Notes
Client presents to ED with report of shortness of breath for 2 days, with headache, chills, fever, sore throat, and cough. States they went to a music concert recently "and probably picked up some kind of virus." Oriented to person, place, and time. Appears lethargic, difficulty answering questioning due to shortness of breath. Follows simple commands, moves all extremities with weakness.
Client's face is flushed, sinus tachycardia, rate of 109/min, S152 heart sounds heard on auscultation. Pulses palpable.
Breath sounds with crackles to right lower lobe, tachypnea, rate of 28/min. Frequent productive cough with thick yellow sputum. Client denies hemoptysis. Unable to lie down, states they are "more comfortable sitting up."
Bowel sounds active x 4 quadrants. Denies diarrhea, last bowel movement yesterday. States "no appetite since I've been sick."
Reports decreased urination over past 24 hr. "Haven't been drinking as much water as I should because my throat hurts."
Client reports they have not had a pneumococcal vaccine and does not get annual influenza vaccinations. States, "I just hate needles."
Diagnostic Results
1230:
Chest x-ray:
Areas of increased density and white infiltrates to lower right lobe indicative of pneumonia
Medical History
1215:
70 years of age
No significant medical history other than primary concern
Well nourished
Home Medications:
Daily multi-vitamin
Vitamin D
Social History.
Lives alone, partner died 5 years ago
Drinks 1 to 2 glasses of red wine daily
Has never smoked
Walks 2 to 3 miles 6 days/week
Question 4 of 5
Select 4 findings in the client's medical record that place them at risk for pneumonia.
Correct Answer: A,C,E,F
Rationale: The client has not received pneumococcal vaccine, which increases susceptibility to pneumococcal pneumonia. The client has not received influenza vaccine, which increases susceptibility to influenza-related pneumonia. The client's fluid intake seems to be reduced, as indicated by their decreased urination and reports of not drinking much water due to a sore throat, which can contribute to the risk of infection. Being 70 years old increases susceptibility to respiratory infections like pneumonia.
Extract:
Question 5 of 5
An older adult client is scheduled to have an elective surgical procedure and informs the nurse that she wants to be designated as a 'do not resuscitate' (DNR) case. Which of the following responses should the nurse provide?
Correct Answer: D
Rationale: The provider should directly discuss the client's wishes regarding a DNR order to ensure understanding and documentation.