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ATI Med Surg Exam 6
Total Questions : 49
Showing 49 questions, Sign in for moreA patient's new onset of dysphagia has required insertion of an NG tube for feeding; the nurse has modified the patient's care plan accordingly. What intervention should the nurse include in the patient's plan of care?
A client who is scheduled for a barium swallow asks the nurse why a laxative is necessary following the procedure. Which of the following responses should the nurse make?
A nurse is admitting a client with suspected appendicitis. Identify where the nurse will palpate to assess for pain at McBurney's point. (Selectable areas, or "Hot Spots," are outlined in the artwork below. Select only the outlined area that corresponds to your answer.)
A nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the patient has a flapping tremor of the hands. The nurse should document the presence of what sign of liver disease?
A nurse is teaching a client who has a hiatal hernia about dietary recommendations. Which of the following client s understanding of the teaching? (Select all that apply)
The nurse is completing the intake and output record for a preschool-age client admitted for fluid volume deficit.
The client has had the following intake and output during the shift:
Intake:
- 4 oz of Pedialyte
- 1/2 of an 8-oz cup of clear orange Jell-O
- 2 graham crackers
- 200 mL of D 5-1/2 sodium chloride IV
Output:
- 345 mL of urine
- 50 mL of loose stool
The nurse documents the client's intake as milliliters. How much liquidintake did the client have in Milliliters?
Round the answer to the nearest whole number.
Explanation
- To convert ounces to milliliters, multiply by 29.57
- 4 oz of Pedialyte = 118.28 mL
- 1/2 of an 8-oz cup of clear orange Jell-O = 118.28 mL
- 2 graham crackers = no liquid intake
- 200 mL of D 5-1/2 sodium chloride IV = 200 mL
- Total intake = 118.28 + 118.28 + 200 = 436.56 mL
- Round to the nearest whole number = 437 mL
- The nurse documents the client's intake as 437 mL
A nurse is preparing dietary instructions for a client who has episodes of biliary colic from chronic cholecystitis.
Which of the following instructions should the nurse include in the teaching plan?
A patient's NG tube has become clogged after the nurse instilled a medication that was insufficiently crushed. The nurse has attempted to aspirate with a large-bore syringe, with no success. What should the nurse do next?
A nurse is assessing a patient who has just been admitted to the postsurgical unit following surgical resection for the treatment of oropharyngeal cancer. What assessment should the nurse prioritize?
- Amylase 450 units/L (20 to 220 units/L)
- Lipase 280 units/L (0 to 160 units/L)
- WBC count 12.500/mm3 (5,000 to 10,000/mm3) RBC count 3.9 (4.2 to 5.4)
- Hemoglobin 8 g/dL (12 g/dL to 16 g/dL for female: 14 to 18 g/dL for male)
- Hematocrit 24% (37% to 47% for female: 42% to 52% for male) Platelet count 160,000/mm3 (150,000 to 400,000/mm3)
- Blood glucose level 250 mg/dL (less than 200 mg/dL)
A nurse is caring for a client who has acute pancreatitis.
Complete the following sentence.
When prioritizing client needs, the nurse should first address the
Explanation
-blood glucose level of 250 mg/dL, which indicates hyperglycemia and can worsen the inflammation of the pancreas
- hemoglobin level of 8 g/dL and hematocrit of 24%, which indicate anemia and can impair oxygen delivery to the tissues
A nurse is caring for a client who has peptic ulcer disease. The nurse should monitor the client for which of the following findings as an indication of gastrointestinal perforation?
A patient's health history is suggestive of inflammatory bowel disease. Which of the following would suggest Crohn's disease, rather than ulcerative colitis, as the cause of the patient's signs and symptoms?
A nurse is teaching a group of adults about screening and prevention of colorectal cancer. The nurse should describe which of the following as the most common sign of possible colon cancer?
A nurse is caring for an older adult who has been experiencing severe Clostridium difficile- related diarrhea. When reviewing the patient's most recent laboratory tests, the nurse should prioritize which of the following?
A child is to receive dexamethasone (Decadron) intravenously at the ordered dosage of 7.6 mg. The drug concentration in the vial is 4 mg/mL. The nurse should administer how many ml?
Explanation
Calculation:
Dosage ordered = 7.6 mg
Drug concentration = 4 mg/mL
7.6 mg / 4 mg/mL = 1.9 mL
A patient with a diagnosis of peptic ulcer disease has just been prescribed omeprazole (Prilosec). How should the nurse best describe this medication's therapeutic action?
A patient seeking care because of recurrent heartburn and regurgitation is subsequently diagnosed with a hiatal hernia. Which of the following should the nurse include in health education?
A nurse is interviewing a client who has acute pancreatitis. Which of the following factors should the nurse anticipate finding in the client's history?
A nurse is performing an abdominal assessment of an older adult patient. When collecting and analyzing data, the nurse should be cognizant of what age-related change in gastrointestinal structure and function?
The physician has ordered Ceclor 0.5 g to be administered orally now. Below you will see the medication label for this medication.
How many milliliters of this medication will this patient receive?
Explanation
- Read the medication label carefully and check the dosage and concentration of Ceclor.
- The label shows that Ceclor is available as a suspension with 250 mg/5 mL.
- To calculate the volume of medication needed, use the formula: Volume = Dose / Concentration
- Plug in the values from the order and the label: Volume = 0.5 g / (250 mg/5 mL)
- Convert grams to milligrams by multiplying by 1000: Volume = 500 mg / (250 mg/5 mL)
- Simplify the fraction by dividing both numerator and denominator by 250: Volume = 2 / (1/5)
- Invert and multiply the fractions: Volume = 2 x 5
- Solve for volume: Volume = 10 mL
- The patient will receive 10 mL of Ceclor suspension.
An adult patient has been diagnosed with diverticular disease after ongoing challenges with constipation. The patient will be treated on an outpatient basis. What components of treatment should the nurse anticipate? Select all that apply.
A nurse is assessing a client who has peptic ulcer disease. Which of the following findings should the nurse identify as the priority?
A nurse is providing instructions for a 52-year-old client who is scheduled for a colonoscopy. The client reports that he has not had the procedure before and is very anxious about feeling pain during the procedure. Which of the following responses by the nurse is appropriate?
A nurse is caring for a patient with hepatic encephalopathy. The nurse's assessment reveals that the patient exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities.
Based on these clinical findings, the nurse should document what stage of hepatic encephalopathy?
A nurse in a PACU is assessing a client who has a newly created colostomy. Which of the following findings should the nurse report to the provider?
A patient has been diagnosed with acute pancreatitis. The nurse is addressing the diagnosis of Acute Pain Related to Pancreatitis. What pharmacologic intervention is most likely to be ordered for this patient?
A patient with a peptic ulcer disease has had metronidazole (Flagyl) added to his current medication regimen. What health education related to this medication should the nurse provide?
A patient's new onset of dysphagia has required insertion of an NG tube for feeding; the nurse has modified the patient's care plan accordingly. What intervention should the nurse
include in the patient's plan of care?
The nurse's comprehensive assessment of a patient includes inspection for signs of oral cancer. What assessment finding is most characteristic of oral cancer in its early stages?
A nurse is teaching a client who has a history of ulcerative colitis and a new diagnosis of anemia. Which of the following manifestations of colitis should the nurse identify as a
contributing factor to the development of the anemia?
During a health education session, a participant has asked about the hepatitis E virus. What prevention measure should the nurse recommend for preventing infection with this virus?
A nurse is providing care for a patient who is postoperative day 2 following gastric surgery.
The nurse's assessment should be planned in light of the possibility of what potential complications? Select all that apply.
The nurse's comprehensive assessment of a patient includes inspection for signs of oral cancer. What assessment finding is most characteristic of oral cancer in its early stages?
Give Ceclor 45mg/kg/day p.o. in 3 divided doses for a patient who weighs 66 pounds. A 75mL stock medication is labeled Ceclor 125mg/mL. How many mLs would the nurse administer per dose?
Units in mL. (Please record your exact answer)
Explanation
- To calculate the dose of Ceclor in mg, multiply the weight in kg by the dosage in mg/kg/day and divide by the number of doses per day.
- To convert pounds to kg, divide by 2.2.
- To calculate the volume of Ceclor in mL, divide the dose in mg by the concentration in mg/mL.
- Convert 66 pounds to kg: 66 / 2.2 = 30 kg
- Calculate the dose of Ceclor in mg: 30 x 45 / 3 = 450 mg
- Calculate the volume of Ceclor in mL: 450 / 125 = 3.6 mL
- The nurse would administer 3.6 mL per dose.
A nurse is providing care for a patient who is postoperative day 2 following gastric surgery.
The nurse's assessment should be planned in light of the possibility of what potential complications? Select all that apply.
A nurse is assessing a client who has cirrhosis. Which of the following is an expected finding for this client?
The management of the patient's gastrostomy is an assessment priority for the home care nurse. What statement would indicate that the patient is managing the tube correctly?
A patient, admitted with a head injury, has an order for DSNS at 125 ml/hour. The IV tubing has a calibration of 15gtt/mL.
What is the correct rate of flow for this patient in gtt/min?
Explanation
- To calculate the correct rate of flow for this patient, we need to use the formula: Rate (gtt/min) = Volume (mL) x Calibration (gtt/mL) / Time (min)
- Plugging in the given values, we get: Rate (gtt/min) = 125 mL x 15 gtt/mL / 60 min
- Simplifying, we get: Rate (gtt/min) = 31.25 gtt/min
- Therefore, the correct rate of flow for this patient is 31.25 gtt/min
A nurse is caring for a client who has ulcerative colitis and is teaching the client about the common link with Crohn's disease. Which of the following information should the nurse
include?
A patient is receiving education about his upcoming Billroth I procedure (gastroduodenostomy). This patient should be informed that he may experience which of the following adverse effects associated with this procedure?
A nurse is caring for an older adult client who reports taking bisacodyl tablets daily. Which of the following responses should the nurse make?
A patient has been brought to the emergency department with abdominal pain and is subsequently diagnosed with appendicitis. The patient is scheduled for an appendectomy but questions the nurse about how his health will be affected by the absence of an appendix. How should the nurse best respond?
A patient who experienced an upper GI bleed due to gastritis has had the bleeding controlled and the patient's condition is stable. For the next several hours, the nurse caring for this patient should assess for what signs and symptoms of recurrence?
A client is prescribed lansoprazole 15 mg PO once a day. At which of the following times should the nurse administer the medication?
A nurse is caring for an older adult client who reports taking bisacodyl tablets daily. Which of the following responses should the nurse make?
A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a patient admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray?
A patient who experienced an upper GI bleed due to gastritis has had the bleeding controlled and the patient's condition is now stable. For the next several hours, the nurse caring for this
patient should assess for what signs and symptoms of recurrence?
A patient has been scheduled for a urea breath test in one month's time. What nursing diagnosis most likely prompted this diagnostic test?
A nurse is caring for a client following an esophagogastroduodenoscopy (EGD) procedure.
Which of the following assessments is the nurse's priority?
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