ATI PN Adult Medical Surgical 2023 III | Nurselytic

Questions 83

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ATI PN Adult Medical Surgical 2023 III Questions

Extract:


Question 1 of 5

Which finding should alert the nurse to a potential bladder infection?

Correct Answer: D

Rationale: Altered mental status in older adults is a common sign of urinary tract infection, requiring attention.

Extract:

Vital Signs
Nurse’s Notes
Diagnostic Results
• Temperature: 39.1 C (102.4° F)

A nurse is reviewing prescriptions from the provider. The prescriptions include:

Provider’s Prescriptions

Obtain daily weight
Obtain blood cultures x2
Swab culture at AVF site
Oxygen at 2 to 4 L nasal cannula for saturation less than 95%
Initiate peripheral venous access
Vancomycin 1 gram by intermittent IV bolus every 12 hr, infuse over 90 minutes
Nutritional consult
Acetaminophen 325 mg PO every 6 hr for temperature greater than 38.3 C (101° F)
Diphenhydramine 25 mg PO every 6 hr


Question 2 of 5

The nurse should first:

Correct Answer: F

Rationale: Obtaining blood cultures first ensures an accurate diagnosis of infection (e.g., from the AVF site) before antibiotics are administered, which could alter culture results.

Extract:


Question 3 of 5

What advice should the nurse provide?

Correct Answer: D

Rationale: A diary correlates activities with heart rhythms, essential for Holter monitor interpretation.

Extract:

Medical History
Vital Signs
Laboratory Findings
The client reports a 24-hour history of fever, chills, weakness, and feeling really bad. The client’s extremities follow simple commands. There is warmth and edema. The client reports pain when the arm is touched. Thrill and bruit are present. Radial pulses are palpable. The client reports no numbness and tingling to the right hand.


Question 4 of 5

The nurse is reviewing the client's findings. The client is at the highest risk for developing..... due to........

Correct Answer: A,G

Rationale: Fever, chills, weakness, and warmth/edema at the AVF site indicate a high risk for sepsis due to infection, a common complication of vascular access sites.

Extract:


Question 5 of 5

Which statement indicates they understand the teaching?

Correct Answer: A

Rationale: Limiting sodium to 2,000 mg/day helps prevent hypertension, a key strategy.

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