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ATI PN Adult Medical Surgical 2023 III
Total Questions : 83
Showing 10 questions, Sign in for moreOver the past 2 months, the client has noticed a significant decrease in his ability to perform daily activities due to fatigue. He also reports a 24-hour history of fever, chills, and weakness. There is erythema around the arteriovenous fistula (AVF) site on his right arm. The client states, “I’ve been having difficulty breathing.” On examination, his breath sounds are clear. He reports no cough. Bowel sounds are active in all four quadrants. He reports no diarrhea and had his last bowel movement yesterday. The client also reports anuria.
A CT Scan of the abdomen/pelvis shows distention with fluid and gas in the small intestine with the absence of gas in the colon.
The client had a cerebrovascular accident 2 years ago. He also has a history of coronary artery disease, hypertension, and hyperlipidemia.
At 0800, the client’s blood pressure was 160/78 mm Hg, temperature was 36.9°C (98.5°F), oxygen saturation was 95% on 2 L/min via nasal cannula, and heart rate was 120/min.
The client has been prescribed morphine for pain management and IV fluids with potassium supplements for hydration and electrolyte balance. A nasogastric tube was inserted into the left nare for nutritional support.
A nurse in a provider’s office is caring for a 68-year-old male client who reports changes in activity tolerance, feeling tired all the time, and difficulty remembering things. The client also states they bruise easily.
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, what actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client’s progress.
Explanation
Condition: The client is most likely experiencing B. Acute Renal Failure. This is suggested by the client’s reported anuria (absence of urine), erythema around the arteriovenous fistula (AVF) site, and the CT scan showing distention with fluid and gas in the small intestine.
Action: The nurse should take the following actions to address this condition:
- A. Administer IV fluids as prescribed: This can help manage the client’s hydration and electrolyte balance.
- E. Administer pain medication as prescribed: This can help manage any discomfort the client may be experiencing.
Parameter: The nurse should monitor the following parameters to assess the client’s progress:
- A. Monitor blood pressure: Monitoring blood pressure is crucial in patients with acute renal failure as both hypotension and hypertension can occur.
- E. Monitor urine output: This is a key indicator of kidney function and should be closely monitored. Changes in urine output can provide early signs of improvement or deterioration in the client’s condition.
1300hrs
The client appears restless and complains of feeling weak. He reports difficulty in breathing and has a persistent cough. His skin is cool and clammy to touch. He is oriented to time, place, and person but appears anxious.
1300hrs
Temperature: 37.2°C (98.9°F), Pulse: 110 bpm, Respiratory rate: 22 breaths/min, Blood pressure: 145/90 mmHg, Oxygen saturation: 92% on room air.
at 1300hrs
WBC count: 9,500/mm (5,000 to 10,000/mm), Hgb: 14 g/dL (12 to 16 g/dL), Hct: 42% (37% to 47%), Sodium: 142 mEq/L (136 to 145 mEq/L), Potassium: 3.2 mEq/L (3.5 to 5 mEq/L), BUN: 28 mg/dL (10 to 20 mg/dL), Fasting
blood glucose: 180 mg/dL (74 to 106 mg/dL), Triglycerides: 200 mg/dL (35 to 135 mg/dL).
At 1300hrs, a nurse is preparing to administer medications to a 68-year-old male client in the cardiac unit. The client’s medications include Furosemide 40 mg PO daily, Potassium chloride 10 mEq/L PO twice daily, Lisinopril 10 mg PO daily, NPH insulin 26 units SUBQ daily, and Atorvastatin 20 mg PO daily.
Based on the findings above, complete the following sentence by using the list of options.The nurse should clarify the prescription for
Explanation
The nurse should clarify the prescription for Furosemide due to the client’s 2. Potassium level. The client’s potassium level is 3.2 mEq/L, which is below the normal range of 3.5 to 5 mEq/L. This could indicate hypokalemia, a condition that can cause weakness, fatigue, and heart rhythm problems. Therefore, it would be important for the nurse to clarify the prescription for potassium chloride, which is a medication used to treat or prevent low potassium levels. Please note that this is an assessment based on the information provided
Furosemide, also known as a loop diuretic, works by inhibiting the Na+/K+/2Cl- cotransporter in the ascending thick loop of Henle in the kidneys1. This part of the kidney is responsible for reabsorbing sodium, chloride, and potassium from the urine back into the body1.
When Furosemide inhibits this process, it leads to an increase in the amount of these electrolytes in the urine, which in turn leads to their decreased levels in the body1. This is why Furosemide can cause a decrease in potassium levels in the body, a condition known as hypokalemia23.
It’s important to note that while Furosemide helps in relieving the body of excess fluid, its use may lead to the depletion of certain electrolytes in the body, such as potassium3. Therefore, if you are taking Furosemide, your doctor may need to monitor your potassium levels or have you consume more potassium4.
The client appears uncomfortable and restless. He is guarding his abdomen, which is distended and tympanic to percussion. His skin is warm and dry to touch, with no signs of jaundice. He continues to deny any tobacco use and admits to drinking 1 to 2 glasses of wine daily.
Cardiovascular: S1, S2, no murmur detected. Respiratory: Bilateral breath sounds clear, no wheezes or crackles noted.
Heart rate: 110/min Temperature: 38.5°C (101.3°F) SpO2: 95% on room air
CT Scan abdomen/pelvis: Shows distention with fluid and gas in the small bowel.
Sodium: 130 mEq/L (136 to 145 mEq/L) Potassium: 3.3 mEq/L (3.5 to 5 mEq/L) WBC count: 10,000/mm (5,000 to 10,000/mm)
A nurse is caring for a 52-year-old male client in the emergency department. It’s now 0800hrs. The client reports worsening mid- abdominal pain, rating it as 8 on a scale of 0 to 10. He states, “I haven’t had a bowel movement in 5 days now.” He also mentions that he has vomited twice since the last assessment.
For each finding, specify if the finding is consistent with small bowel obstruction or acute pancreatitis. Each finding may support more than one disease process.
Explanation
- Abdominal Pain: Common in both small bowel obstruction and acute pancreatitis.
- No Bowel Movement for 5 days: More indicative of small bowel obstruction.
- Vomiting: Can occur in both conditions.
- Abdominal Distention: Seen in both small bowel obstruction and acute pancreatitis.
- Increased Heart Rate: Can be a response to pain or infection in both conditions.
- Elevated Temperature: Can occur in both conditions due to inflammation or infection.
- Distention with fluid and gas in the small bowel (CT Scan): Specific to small bowel obstruction.
- Sodium: 130 mEq/L: Hyponatremia can be seen in both conditions.
- Potassium: 3.3 mEq/L: Hypokalemia can be seen in both conditions.
- WBC count: 10,000/mm: Leukocytosis can be seen in both conditions due to inflammation.
• Blood pressure: 92/60 mm Hg
• Pulse: 106/min
• Temperature: 38.3 C (101F)
• Oxygen saturation: 95%
• Provider’s prescription: Place client on NPO status.
• The client reports mild abdominal pain, rating it as 7 on a scale of 0 to 10.
• The client states, “I haven’t had a bowel movement in 4 days.”
• The client states, “I also have vomited once or twice.”
• General: Uncomfortable, grimacing
• HEENT: Dry mucous membranes
• Cardiovascular: S1, S2, no murmurs
• Respiratory: Bilateral breath sounds clear
• Gastrointestinal: Tenderness to palpation, high-pitched bowel sounds
• Skin: No jaundice noted
• Social history: Drinks 1 to 2 glasses of wine daily. Client reports no tobacco use.
• Sodium: 130 mEq/L (Normal range: 136 to 145 mEq/L)
• Potassium: 3.3 mEq/L (Normal range: 3.5 to 5 mEq/L)
• BUN: 25 mg/dL (Normal range: 10 to 20 mg/dL)
• Creatinine: 1.3 mg/dL (Normal range: 0.5 to 1.1 mg/dL)
• WBC count: 9,000/mm (Normal range: 5,000 to 10,000/mm)
• Serum amylase: 100 units/L (Normal range: 30 to 220 units/L)
• Serum lipase: 40 units/L (Normal range: 0 to 160 units/L)
The nurse is assisting with the care of a client.
The nurse is collecting data on the client. Which of the following findings require follow-up?
The client reports that over the past 2 months they have noticed multiple changes with their body. They have a decrease in activity tolerance, feel tired all the time, and have had difficulty remembering things. The client also states they bruise easily, are experiencing constipation, and they no longer tolerate the cold like they used to. The client is concerned about exposure to seasonal viruses from other patrons. Reports that they are currently experiencing a headache with a pain of 3 on a scale of 0 to 10.
• Temperature: 36.6°C (97.9 F) • Heart rate: 54/min • Respiratory rate: 22/min • Blood pressure: 94/50 mm Hg • Oxygen saturation: 94% on room air • Pain level: 2 on a scale of 0 to 10 • Weight: 111.6 kg (246 Ib), Reports gain of 3.2 kg (7 Ib) over the past 2 months
The client has a history of bipolar disorder and has been on medication for the same. There is no history of any other chronic illnesses. The client has been generally healthy with regular check-ups showing normal results. The client does not smoke or consume alcohol.
The client has been prescribed Lithium 300 mg PO three times daily for bipolar disorder, Levothyroxine 50 mcg PO daily for thyroid function, and Sumatriptan 25 mg PO PRN for migraine pain.
On physical examination, the client appears fatigued and has a slow gait. Skin appears dry and cool to touch. There are a few bruises noted on the arms and legs. The client’s reflexes are sluggish.
A nurse in a provider’s office is caring for a 68-year-old male client who reports changes in their health over the past 2 months. The client has been on medication for bipolar disorder and has been taking Lithium 300 mg PO three times daily, Levothyroxine 50 mcg PO daily, and Sumatriptan 25 mg PO PRN for migraine pain.
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client’s progress.
Explanation
Based on the symptoms and information provided, the client is most likely experiencing Hypothyroidism. Here is how you can complete the diagram:
Condition:
- A. Hypothyroidism
Actions:
- A. Monitor the client for constipation
- B. Reinforce teaching the client about levothyroxine
Parameters:
- D. Monitor weight changes
- E. Monitor heart rate
• Temperature: 39.1 C (102.4° F)
• Right arm at arteriovenous fistula (AVF) site with erythema
- Red blood cell count: 3.5 million/mm (Normal range: 4.2 to 5.4 million/mm)
- Hematocrit: 27% (Normal range: 37.9% to 47.6%)
- Platelet count: 100,000/mm (Normal range: 150,000 to 400,000/mm²)
- Potassium: 5.1 mEq/L (Normal range: 3.5 to 5 mEq/L)
- Calcium: 8.5 mg/dL (Normal range: 9 to 10.5 mg/dL)
- Vitamin D: 22 ng/mL (Normal range: 25 to 80 ng/mL)
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
The nurse should first:
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.
- Temperature: 39.1°C (102.4°F)
- Oxygen saturation: 93% on room air
Complete Blood Count:
- White blood cell count: 15,000/mm (Normal: 5,000 to 10,000/mm)
- Red blood cell count: 3.5 million/mm (Normal: 4.2 to 5.4 million/mm)
- Hemoglobin: 9 g/dL (Normal: 12 to 16 g/dL)
- Hematocrit: 27.9% (Normal: 37% to 47%)
- Platelet count: 100,000/mm (Normal: 150,000 to 400,000/mm)
Basic Metabolic Profile (BMP):
- Sodium: 152 mEq/L (Normal: 136 to 145 mEq/L)
- Potassium: 5.1 mEq/L (Normal: 3.5 to 5 mEq/L)
- Glucose: 148 mg/dL (Normal: 74 to 106 mg/dL)
- BUN: 45 mg/dL (Normal: 10 to 20 mg/dL)
- Creatinine: 4.5 mg/dL (Normal: 0.5 to 1 mg/dL)
- Calcium: 8.5 mg/dL (Normal: 9 to 10.5 mg/dL)
- Vitamin D: 22 ng/mL (Normal: 25 to 80 ng/mL)
The nurse is reviewing the client’s findings. The client is at the highest risk for developing
Explanation
Based on the client’s symptoms and laboratory findings, the client is at the highest risk for developing sepsis due to white blood cell count.
Sepsis is a severe response to infection, and the elevated white blood cell count (15,000/mm³) along with fever, chills, and other symptoms indicate a significant infection that could lead to sepsis.
- Temperature: 37.1° C (98.7 F)
- Heart rate: 110/min
- Respiratory rate: 25/min
- SpO2: 86%
- Blood pressure: 118/76 mm Hg
- ABG results:
- pH: 7.27 (Normal range: 7.35 to 7.45)
- PaO2: 66 mm Hg (Normal range: 80 to 100 mm Hg)
- PaCO2: 50 mm Hg (Normal range: 35 to 45 mm Hg)
- HCO3: 26 mEq/L (Normal range: 21 to 28 mEq/L)
- WBC Count: 8,000/mm² (Normal range: 5,000 to 10,000/mm)
- RBC count: 5.1 million/mm (Normal range: 4.2 to 6.1 million/mm)
- Hgb: 17 g/dL (Normal range: 12 to 18 g/dL)
- Hct: 43.9% (Normal range: 37.9% to 52.9%)
The client has a history of seasonal allergies and smokes 1 pack of cigarettes per day.
A nurse is assisting with the care of a client in the emergency department. The client is alert and oriented x3. Wheezing is noted on exhalation with a prolonged breathing cycle. The cough is nonproductive. Use of accessory muscles is noted while breathing. The oral mucosa and lips are cyanotic. Nasal flaring is noted. The client experiences difficulty talking.
The nurse is assisting in planning care. Complete the diagram by dragging from the choices below to specify:
- What condition the client is most likely experiencing.
- Two actions the nurse should take to address that condition.
- Two parameters the nurse should monitor to assess the client’s progress.
Explanation
Based on the provided information, here’s how the diagram should be completed:
- Condition the client is most likely experiencing:
- Asthma
- Actions the nurse should take to address that condition:
- Administer albuterol
- Monitor ABGs
- Parameters the nurse should monitor to assess the client’s progress:
- Oxygen saturation
- Breath sounds
• Postoperative day 1: Temperature 36.4°C (97.5°F), Respiratory rate 18/min
• Postoperative day 1: Lung sounds clear bilaterally. Skin warm and dry to touch. Capillary refill 2 seconds. Radial and pedal pulses 2+.
- Sodium: 142 mEq/L (136 to 145 mEq/L)
- Potassium: 5.4 mEq/L (3.5 to 5 mEq/L)
- Total calcium: 10.1 mg/dL (9.0 to 10.5 mg/dL)
- Magnesium: 1.9 mEq/L (1.3 to 2.1 mEq/L)
- Hemoglobin (Hgb): 14 g/dL (14 to 18 g/dL)
- Hematocrit (Hct): 42% (42% to 52%)
- White Blood Cell (WBC) count: 7,000/mm³ (5,000 to 10,000/mm³)
- Postoperative day 2, 2300: Temperature 36.3°C (97.3°F)
- Postoperative day 2, 0600: Temperature 36.4°C (97.2°F), Heart rate 94/min, Respiratory rate 20/min, Blood pressure 108/68 mm Hg
- Hemoglobin (Hgb): 10.5 g/dL (14 to 18 g/dL)
- Hematocrit (Hct): 38.9% (42% to 52%)
- White Blood Cell (WBC) count: 8,500/mm³ (5,000 to 10,000/mm³)
- Platelet count: 203,000/mm³ (150,000 to 400,000/mm³)
- Fasting blood glucose: 86 mg/dL (74 to 106 mg/dL)
- Postoperative day 2, 0600: Client is drowsy but alert to voice. Lung sounds clear bilaterally. Capillary refill 2 seconds. Radial and pedal pulses 2+.
The nurse is continuing to assist in the care of the client post-surgery. The test-taker must interpret the following exhibits to answer the question.
The nurse is assisting with evaluating the client’s responses to interventions.
- Fasting blood glucose: 90 mg/dL (Normal range: 74 to 106 mg/dL)
- Sodium: 142 mEq/L (Normal range: 136 to 145 mEq/L)
- Total calcium: 10.1 mg/dL (Normal range: 9.0 to 10.5 mg/dL)
- Magnesium: 1.9 mEq/L (Normal range: 1.3 to 2.1 mEq/L)
- Phosphate: 4.1 mg/dL (Normal range: 3 to 4.5 mg/dL)
- Hematocrit (Hct): 42% (Normal range: 42% to 52%)
- Temperature: 36.4°C (97.5°F)
- Oxygen saturation: 97% on room air
- The client appears anxious and restless.
- The client reports a sharp pain in the chest area.
- Lung sounds are clear bilaterally upon auscultation.
- The client’s respirations are rapid and shallow.
A nurse is assisting in the care of a 52-year-old male client in the emergency department. It’s 0700hrs. The client reports feeling anxious and having chest pain. The nurse reviews the client’s electronic medical record.
After reviewing the client’s electronic medical record, which of the following actions should the nurse recommend to take? Select the 3 actions the nurse should recommend.
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