ATI RN
ATI RN Adult Medical Surgical 2023 III Questions
Extract:
Medical History
Conditions:
• Dehydration
• Hyperlipidemia
• Hypertension
• Coronary artery disease (CAD)
Diagnostic Results
• WBC Count: 14,000/mm³ (Normal: 5,000 to 10,000/mm³)
• Hemoglobin (Hgb): 14 g/dL (Normal: 12 to 16 g/dL)
• Hematocrit (Hct): 40% (Normal: 34 to 47%)
• Sodium: 132 mEq/L (Normal: 136 to 146 mEq/L)
• Potassium: 6.2 mEq/L (Normal: 3.5 to 5 mEq/L)
• Calcium: 10 mg/dL (Normal: 9 to 10.5 mg/dL)
• BUN: 20 mg/dL (Normal: 10 to 20 mg/dL)
• Albumin: 2.8 g/dL (Normal: 3.5 to 5 g/dL)
• Fasting Blood Glucose: 140 mg/dL (Normal: 74 to 106 mg/dL)
• Triglycerides: 134 mg/dL (Normal: 34 to 160 mg/dL)
Nurses' Notes
Client is lying in bed. Awake, alert, and oriented to time, place, and person. Client is febrile and reports weakness. Receiving TPN via central line in left antecubital. Client is NPO and has had diarrhea x3 in past 4 hr. Crackles auscultated in posterior lobes.
Client has a productive cough and sputum is yellow in color. Client receiving 2 L/min oxygen via nasal cannula with an oxygen saturation of 90%. Abdomen is distended and tender. Active range of motion to all extremities. Denies pain at this time.
Question 1 of 5
Which of the following actions should the nurse take? For each potential nursing intervention, click to specify if the potential intervention is anticipated, nonessential, or contraindicated for the client.
| Options | Anticipated | Nonessential | Contraindicated |
|---|---|---|---|
| Obtain client weight twice daily. | |||
| Have 3 nurses verify the TPN solution prescription. | |||
| Request a prescription for insulin. | |||
| Request an antibiotic to be administered. | |||
| Decrease the client's oxygen to 1.5 L/min oxygen via nasal cannula. | |||
| Notify provider to increase TPN rate/hr. |
Correct Answer: (See rationale)
Rationale: Weight monitoring and insulin are anticipated for CAD and dehydration; TPN verification is nonessential; antibiotics and oxygen reduction are contraindicated without indication.
Extract:
Question 2 of 5
A nurse is caring for a client who has a sealed radiation implant. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: Limiting family member visits to 30 minutes per day reduces radiation exposure to others, which is a key safety measure for clients with sealed radiation implants.
Question 3 of 5
A nurse is admitting a client who has meningitis. Which of the following findings should the nurse expect?
Correct Answer: B
Rationale: Photophobia is a common symptom of meningitis due to meningeal irritation affecting the eyes.
Question 4 of 5
A nurse on a medical-surgical unit is planning care for a client who has dementia and a history of wandering. Which of the following actions should the nurse plan to implement?
Correct Answer: C
Rationale: A bed alarm alerts staff to wandering attempts, enhancing safety for a client with dementia.
Question 5 of 5
A nurse is caring for a client who has acute angina. Which of the following actions should the nurse take first?
Correct Answer: A
Rationale: Nitroglycerin is the first-line treatment for acute angina to relieve chest pain by dilating coronary arteries.