Case

ATI RN Adult Medical Surgical Online Practice

ATI RN Adult Medical Surgical Online Practice Nursing 350 ATI RN Adult Medical Surgical Online Practice 2016 B 1. A nurse is providing dietary... [Show More] teaching to a client who has celiac disease. Which of the following choices should the nurse identify as an indication that the client understands the teaching? = Grilled chicken breast R: Celiac disease people should avoid gluten. Grilled chicken breast does not have gluten. Chocolate pudding contains wheat starch. 2. A nurse is developing a teaching plan for a client who has gout. Which of the following recommendations should the nurse include? = Decrease intake of purine meats 3. A nurse is assessing a client who has a comminuted fracture of the femur. Which of the following should the nurse identify as an early manifestation of a fat embolism? = Dyspnea R: Dyspnea, along with tachypnea and a decreased arterial oxygen level are signs of a fat embolism. 4. A nurse is caring for a client who has a cervical spinal cord injury sustained 1 month ago. Which of the following manifestations indicates that the client is experiencing autonomic dysreflexia? = heart rate 52/min R: Other manifestations include significant rise in systolic and diastolic pressures, severe headache, and flushing. 5. A nurse caring for a client who has pancreatitis. The nurse should expect which of the following laboratory results to be below the expected reference range? = Calcium R: Client with pancreatitis is expected to have decreased calcium and magnesium levels due to fat necrosis. 6. A nurse is providing teaching to a client who has a recent diagnosis of constipation-predominant irritable bowel syndrome. Which of the following instructions should the nurse include in the teaching? = Consume at least 30 g of fiber daily 7. A nurse is teaching a client who has a cardiac dysrhythmia about the purpose of undergoing continuous telemetry monitoring. Which of the following statements by the client reflects an understanding of the teaching? = “This identifies if the pacemaker cells of my heart are working properly.” 8. A nurse is planning care for a client who has community-acquired pneumonia. Which of the following interventions should the nurse include in the plan of care? = Monitor the client for confusion R: Pneumonia is an inflammatory process resulting in increased exudate and a thickening and narrowing of the airways, which causes hypoxia. The reduced oxygen level places the client at risk for confusion. 9. A nurse in an ICU is assessing a client who has a traumatic brain injury. Which of the following findings should the nurse identify as a component of Cushing’s triad? = Bradycardia R: The other two components are severe hypertension and a widened pulse pressure. 10. A nurse is administering meperidine IM in the right deltoid of a client. The nurse aspirates and pulls back blood in the syringe. Which of the following actions should the nurse take? = Dispose of the medication. R: The presence of blood indicates improper needle placement. The medication and needle are now contaminated. 11. A nurse is providing teaching to a client who is receiving chemotherapy and has a new prescription for epoetin alfa. Which of the following client statements indicates an understanding of the teaching? = “I will monitor my blood pressure while taking this medication.” R: HTN is a common adverse effect and can lead to hypertensive encephalopathy. 12. A nurse is caring for a client who is undergoing renal dialysis to treat end-stage kidney disease. The client reports muscle cramps and a tingling sensation in his hands. Which of the following medications should the nurse plan to administer? = Calcium carbonate R: Hypocalcemia is a manifestation of ESKD and an adverse effect of dialysis. 13. A nurse is providing teaching to a client who is at risk for developing type 1 diabetes. The nurse should inform the client that which of the following manifestations indicates diabetes? (Select all) * Polyuria * Polydipsia * Neuropathy 14. A nurse is reviewing the laboratory results of a client who has cirrhosis. Which of the following laboratory values should the nurse expect? = Elevated bilirubin level 15. A nurse is providing discharge instructions to a client following an upper gastrointestinal series with barium contrast. Which of the following information should the nurse provide? = Increase fluid intake R: To get rid of the barium that was used during the test. 16. A home health nurse is assigned to a client who has recently discharged form a rehabilitation center after experiencing a right hemispheric cerebrovascular accident (CVA). Which of the following neurologic deficits should the nurse expect to find when assessing the client? (Select all) * Visual spatial deficits * Left hemianopsia * One-sided neglect 17. A nurse is caring for a client who has portal hypertension. The client is vomiting blood mixed with food after a meal. Which of the following actions should the nurse take first? = Obtain vital signs 18. A nurse in an emergency department is caring for a client who reports chest pain of 8 out of 10. Which of the following actions should the nurse take first? = Administer morphine R: Treat the pain before you do anything else. 19. A nurse is caring for a client who has a peripherally inserted central catheter (PICC). Which of the following actions should the nurse take to manage the PICC? = Flush the PICC line with 10 mL NS before and after medication administration 20. A nurse is caring for a client who has type 1 diabetes mellitus and has had acute bronchitis for the past 3 days. Which of the following statements should the nurse include when instructing the client? = “Take insulin even if you are unable to eat your regular diet.” 21. A nurse is preparing to administer a unit of packed RBCs to a client. Which of the following actions should the nurse take? = Remain with the client for the first 15 min of the infusion. 22. A nurse is assessing a client following IV urography. Which of the following findings is the priority? = Swollen lips R: Indicates client is having an anaphylactic reaction to the contrast, which is the greatest risk. Tricky one! Thought it would be the decreased urine output. 23. A nurse is assessing a client who is postoperative following a transurethral resection of the prostate (TURP) and notes clots in the client’s indwelling urinary catheter and a decrease in urinary output. Which of the following actions should the nurse take? = Irrigate the indwelling urinary catheter R: To get rid of the clots, duh!  24. A nurse on a medical-surgical unit is reviewing the medical record of an older adult client who is receiving IV fluid therapy. Which of the following client information should indicate to the nurse that the client requires a revision of the IV therapy prescription? = BUN level R: It’s higher than it should be, which can indicate dehydration and the client may need an increase in the IV fluid infusion rate. 25. A nurse is obtaining a health history of a client who has an abdominal aortic aneurysm. Which of the following findings should the nurse expect? = Bruit heard over the middle upper abdomen 26. A nurse is reviewing the medical record of a client who is taking warfarin for chronic atrial fibrillation. Which of the following values should the nurse identify as a desired outcome for this therapy? = INR 2.5 27. A nurse is caring for a client who has diabetic ketoacidosis (DKA). Which of the following laboratory findings should the nurse expect? = BUN 32 mg/dL 28. A nurse is reviewing the laboratory results of a client who had a recent exposure to hepatitis C virus. Which of the following tests should the nurse identify as indicating the presence of hepatitis C antibodies? = Enzyme immunoassay 29. A nurse is administering packed RBCs to a client. Which of the following assessment findings indicates a hemolytic transfusion reaction? = Low back pain and apprehension R: Causes a systemic inflammatory response. Other symptoms include hypotension and tachycardia. 30. A home health nurse is providing teaching to a client who has a stage 1 pressure ulcer on the greater trochanter of his left hip. Which of the following instructions should the nurse include in the teaching? = Change position every hour R: It will decrease pressure on bony prominences. The donut-shaped pillow is incorrect because it can damage capillary beds, resulting in further skin breakdown. 31. A nurse is caring for a client who is 4 hr postoperative following an open reduction internal fixation (ORIF) of the right ankle. Which of the following assessment findings should the nurse report to the provider? = Extremity cool upon palpation 32. A nurse in an ICU is planning care for a client who is in cardiogenic shock. The nurse should prepare to administer which of the following medications to increase cardiac output? = Dopamine R: Dopamine is inotropic and improves CO by strengthening the force of contractions. It also raises BP by causing vasoconstriction. 33. A nurse is providing teaching to a client who takes ginkgo biloba as an herbal supplement. Which of the following statements should the nurse make? = “Ginkgo biloba can cause an increased risk for bleeding.” 34. A nurse is providing teaching to a client who has angina and a new prescription for sublingual nitroglycerin. Which of the following instructions should the nurse include? = Store the medication in its original container R: Nitroglycerin can be inactivated by heat, light, and moisture. Should be kept in the dark glass container that it comes in. 35. A nurse is caring for a client who is receiving total parenteral nutrition (TPM) and is NPO. When reviewing the chart, the nurse notes the following prescription: capillary blood glucose AC and HS. Which of the following actions should the nurse take? = Contact the primary care provider to clarify the prescription. R: Mealtimes do not pertain to this client due to the NPO status. 36. A nurse is reviewing the health record of a client who is scheduled for allergy skin testing. The nurse should postpone the testing and report to the provider which of the following findings? = Current medications R: Client is on prednisone which can diminish the client’s reaction to allergens. Should be discontinued for 2 weeks before allergy testing. 37. A nurse is caring for a client who is receiving a blood transfusion. The client becomes restless, dyspneic, and has crackles noted to the lung bases. Which of the following actions should the nurse anticipate taking? = Slow the infusion rate. R: Client is having symptoms of circulatory overload. 38. A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect? = Low urine specific gravity 39. A nurse is caring for a client who has a potassium level of 3 mEq/L. Which of the following assessment findings should the nurse expect? = Hypoactive bowel sounds 40. A nurse is caring for a client who has had a cerebrovascular accident. Which of the following findings indicates that the client has homonymous hemianopsia? = The client has to turn her head to see the entire visual field. 41. A nurse is planning to irrigate and dress a clean, granulating wound for a client who has a pressure ulcer. Which of the following actions should the nurse take? = Use a 30 mL syringe R: This size provides the right about of pressure when irrigating a wound. 42. A nurse is providing teaching to a client who has a severe form of stage II Lyme disease. Which of the following statements made by the client reflects an understanding of the teaching? = “My joints ache because I have Lyme disease.” R: The disease occurs in three stages beginning with joint and muscle pain in stage 1. If left untreated, these symptoms continue throughout stage II, stage II, then become chronic. 43. A nurse in a provider’s office is assessing a client who has hypertension and takes propranolol. Which of the following findings should indicate to the nurse that the client is experiencing an adverse reaction to this medication? = Report of a night cough. 44. A nurse is assessing heart sounds of a client who reports substernal precordial pain. Identify which of the following sounds the nurse should document in the client’s medical record by listening to the audio clip. = Pericardial friction rub R: A pericardial friction rub is a scratchy, high-pitched sound associated with infection, inflammation, or infiltration and can be a sign of pericarditis. 45. A nurse is caring for a client 1 hour following a cardiac catherization. The nurse notes the formation of a hematoma at the insertion site and a decreased pulse rate in the affected extremity. Which of the following interventions is the nurse’s priority? = Apply firm pressure to the insertion site. 46. A nurse is caring for a client who has amyotrophic lateral sclerosis (ALS) and is being admitted to the hospital with pneumonia. Which of the following assessment findings is the nurse’s priority? = Increased respiratory secretions 47. A nurse is receiving a report on a client who is postoperative following an open repair of Zenker’s diverticulum. The nurse should anticipate the surgical incision to be in which of the following locations? (ON the diagram) = A (the neck area) 48. A nurse is providing teaching to a client who has esophageal cancer and is to undergo radiation therapy. Which of the following statements should the nurse identify as an indication that the client understands the teaching? = “I will use my hands rather than a washcloth to clean the radiation area.” R: The client should wash the radiation area gently with their hands using warm water and mild soap. Client should avoid direct sunlight during radiation treatments and for at least 1 year after therapy. 49. A nurse is caring for a client who has active bleeding from a peptic ulcer disease. Which of the following findings is an indication that the client is experiencing compensatory shock? = Increased heart rate 50. A nurse is caring for a client who has cirrhosis of the liver with esophageal varices. Which of the following activities should the nurse instruct the client to avoid? = Straining to have bowel movements. 51. A nurse is caring for a client who has hepatic encephalopathy that is being treated with lactulose. The client is experiencing excessive stools. Which of the following findings is an adverse effect of this medication? = Hypokalemia 52. A nurse is providing teaching to a client who has a new diagnosis of type 1 diabetes and is planning a trip. Which of the following instructions should the nurse include in the teaching? = “Take additional pairs of shoes.” 53. A nurse is providing teaching to a client who has end-stage kidney disease and is waiting for a kidney transplant. Which of the following information should the nurse provide? = Hemodialysis is sometimes needed following surgery. R: Because the new kidney might not function immediately. 54. A nurse is caring for a client who has HIV. Which of the following findings indicates a positive response to the prescribed HIV treatment? = Decreased viral load 55. A nurse is assessing a client who has Cushing’s disease. Which of the following findings should the nurse expect? = Muscle atrophy 56. A client who has emphysema is receiving mechanical ventilation. The client appears anxious and restless, and the high-pressure alarm is sounding. Which of the following actions should the nurse take first? = Instruct the client to allow the machine to breathe for him. R: Clients can be anxious and restlessness when trying to “fight the ventilator.” 57. A nurse is teaching a group of newly licensed nurses about pain management for older adult clients. Which of the following statements by a newly license nurse indicates an understanding of the teaching? = “Ibuprofen can cause gastrointestinal bleeding in older adult clients.” 58. A nurse is providing teaching to a client who has hypertension and a new prescription for verapamil. Which of the following statements by the client indicates an understanding of the teaching? = “I will count my heart beats before taking this medication.” 59. A nurse is caring for a client who is experiencing an acute myocardial infarction. The nurse should identify which of the following findings as a manifestation of cardiogenic shock? = Hypotension 60. A nurse is caring for a client who has viral pneumonia. The client's pulse oximeter readings have fluctuated between 79% and 88% for the last 30 minutes. Which of the following oxygen delivery systems should the nurse initiate to provide the highest concentration of oxygen? = Nonrebreather mask R: Nonrebreather mask delivers between 80% to 95% oxygen to the client. A client who has an unstable respiratory status needs a nonrebreather mask. A venturi mask is for clients that require exact oxygen flow amounts. Venturi mask can only deliver oxygen concentrations between 24% and 50%. 61. A nurse is conducting an admission history for a client who is to undergo a CT scan with an IV contrast agent. The nurse should identify that which of the following findings requires further screening? = Shellfish allergy 62. A nurse is reviewing the laboratory report of a client who is receiving non-surgical treatment for Cushing’s disease. Which of the following laboratory findings should the nurse identify as in positive outcome of the treatment? = Decreased sodium 63. A nurse is reviewing the laboratory findings of a client who developed chest pain six hours ago. The nurse should identify which of the following findings as an indication of a myocardial infarction? = Troponin I 8 ng/mL R: Troponins are proteins that are present in skeletal and cardiac muscle that are involved with muscle contraction. The elevation of either troponin T or troponin I is an indication of cardiac injury. 64. A nurse is assessing an older adult client who has heart failure and takes digoxin. Which of the following findings should the nurse recognize as an indication of digoxin toxicity? = Bradycardia R: The nurse should recognize that bradycardia is an early indication of digoxin toxicity. Digoxin toxicity is more common in older adult clients due to decreased renal excretion of the medication. Other indications of digoxin toxicity include anorexia, nausea, and visual disturbances. Digoxin toxicity can occur as a result of hypokalemia and are seen when digoxin levels are greater than 0.8 ng/mL. 65. A nurse is providing teaching for a female client who has recurrent urinary tract infections. Which of the following information should the nurse include in the teaching? = Void before and after intercourse. 66. The nurse is caring for a newly admitted client who has gastric hemorrhage and is going into shock. Identify the sequence of actions the nurse should take. 1- Administer oxygen via a nonrebreather mask. 2- Initiate IV therapy 3- Insert an NG tube (to monitor for the rate of bleeding and prevent gastric dilation) 4- Administer ranitidine 67. A nurse is planning care for a client who has a sealed radiation implant for cervical cancer. Which of the following interventions should the nurse include in the plan of care? = Keep a lead-lined container in the client’s room. R: The nurse should keep a lead lined container and forceps in the client’s room in case of accidental dislodgement of the implant. Visitors should be limited to only 30 min per day. 68. A nurse is caring for a client who has diabetic ketoacidosis (DKA). Which of the following should the nurse plan to administer? = Regular insulin 20 units IV bolus R: Regular insulin is a fast-acting insulin that can be effective within 10 minutes when administered intravenously. 69. A nurse is preparing a client who has supraventricular tachycardia for elective cardioversion. Which of the following prescribed medications should the nurse instruct the client to withhold for 48 hours prior to cardioversion? = Digoxin R: Cardiac glycosides, such as digoxin, are withheld prior to cardioversion. These medications can increase ventricular irritability and put the client at risk for ventricular fibrillation after the synchronized counter shock of cardioversion. 70. A nurse is caring for a client who has a stage III pressure ulcer. Which of the following findings contributes to delayed wound healing? = Urine output 25 mL/hr R: Urinary output is a reflection of fluid status. In adequate urine output can indicate dehydration, which can delay wound healing. 71. A nurse is caring for a client who has a pneumothorax and a closed-chest drainage system. Which of the following findings is an indication of lung re expansion? = Bubbling in the water seal chamber has ceased. R: Bubbling in the water seal chamber ceases when the lung re-expands. 72. A nurse is assessing a client following the administration of IV penicillin G. Which of the following findings should indicate to the nurse if the client is experiencing an anaphylactic reaction? = Flushing R: The nurse should identify facial flushing as a manifestation of an anaphylactic reaction to penicillin. The nurse should monitor the client’s airway in prepare to administer oxygen and epinephrine. 73. A nurse is providing discharge instructions to a client who has partial thickness burn of the hand. Which of the following instructions should the nurse include? = Wrap fingers with individual dressings. R: the nurse should instruct the client to wrap the fingers individually to allow for functional use of the hand while healing occurs. 74. A nurse is caring for a client who has increased intracranial pressure (ICP)and is receiving mannitol via continuous IV infusion. The nurse report which of the following adverse effects of this medication to the provider? = Crackles heard on auscultation R: Mannitol is an osmotic diuretic that prevents the reabsorption of water in the kidneys, thus increasing urinary output. With the exception of the brain, mannitol can leave the vascular system at the capillary site, which can result in edema. The nurse should identify crackles as a manifestation of pulmonary edema and notify the provider. Other manifestations include dyspnea and decreased oxygen saturation 75. The nurse is assessing a client who is at risk for the development of pernicious anemia resulting from peptic ulcer disease. Which of the following images depicts a condition caused by pernicious anemia? = [picture of the tongue that looks smooth and kind of shiny] R: This image depicts glossitis, which can indicate pernicious anemia. Glossitis, a smooth red tongue, is also a manifestation of deficiencies in vitamin B6, zinc, niacin, or folic acid. 76. A nurse is caring for a client who is experiencing a tonic clonic seizure. Which of the following actions should the nurse take? = Loosen restrictive clothing 77. A nurse is assessing a client who is receiving morphine via a PCA pump. Which of the following findings indicates an adverse effect of the medication? = Urinary retention Because morphine causes urinary retention, the nurse should frequently monitor the client’s urinary output and check for bladder distention. 78. A nurse in an emergency Department is assessing client who has a detached retina. Which of the following should the nurse expect the client to report? = “It's like a curtain closed over my eye.” a retinal detachment is a separation of the retina from the epithelium. It can occur because of trauma, cataract surgery, retinopathy, or uveitis. Clients who have retinal detachment typically report the sensation of a curtain being pulled over part of the visual field. 79. A nurse is assessing a client following the administration of magnesium sulfate 1 g IV bolus. For which of the following adverse effects should the nurse monitor? = Respiratory paralysis R: The nurse should monitor a client who is receiving magnesium sulfate via IV bolus closely as the adverse effects can impact the CNS, the cardiovascular system, and the respiratory system. Respiratory paralysis is a life-threatening adverse effect of magnesium sulfate. 80. A nurse is assessing a client's hydration status. Which of the following findings indicates fluid volume overload? = Distended neck veins 81. A nurse is assessing a client who had extracorporeal shockwave lithotripsy (ESWL) 6 hours ago. Which of the following findings should the nurse expect? = Stone fragments in the urine R: ESWL is an effort to break the calculi so that the fragments passed down the ureter, into the bladder, and through the urethra during voiding. Following the procedure, the nurse should strain the client's urine to confirm the passage of stones. 82. A nurse is assessing a client who has a diagnosis of rheumatoid arthritis. Which of the following nonpharmacological interventions should the nurse suggest to the client to reduce pain? = Alternate application of heat and cold to the affected joints R: The nurse should instruct the client to alternate heat and cold applications to decrease joint inflammation and pain. The application of cold can relieve joint swelling and the application of heat can decrease joint stiffness and pain. 83. A nurse is providing teaching to a client who has hypothyroidism and is receiving levothyroxine period the nurse should instruct the client that which of the following supplements can interfere with the effectiveness of the medication? = Calcium R: Calcium limits the development of osteoporosis in women who are post-menopausal and works as an antacid. Calcium supplements can interfere with the metabolism of a number of medications, including levothyroxine. The nurse should instruct the client to avoid taking calcium within 4 hours of levothyroxine administration. 84. A nurse is assessing a client who was taken carvedilol all for heart failure. Which of the following findings is a priority for the nurse to report to the provider? = Weight gain R: The nurse should report weight gain because it can indicate a worsening of the client's heart failure and requires immediate intervention. 85. The client who has a diagnosis of Clostridium difficile is placed on contact precautions. Which of the following actions should the nurse take? = Leave a stethoscope in the room for blood pressure monitoring 86. A nurse is providing education to a client who has tuberculosis and his family. Which of the following information should the nurse include in the teaching? = Family members in the household should undergo TB testing. R: Family members who live in the same household with the client have been exposed to TB. Therefore, the nurse should recommend TB screening to foster early detection and treatment of TB. 87. A nurse admits a client who has anorexia, low grade fever, night sweats, and a productive cough. Which of the following actions should the nurse take first? = Initiate airborne precautions 88. An older adult client is brought to an emergency Department by a family member. Which of the following assessment findings should cause the nurse to suspect that the client has hypertonic dehydration? = Urine specific gravity is 1.045 R: A urine specific gravity greater than 1.030 indicates a decrease in urine volume and an increase in osmolarity, which is a manifestation of hypertonic dehydration. 89. A nurse is reviewing the laboratory results of a client who has aids and is taking amphotericin B for a fungal infection. The nurse should identify that which of the following values is an indication of an adverse effect of this medication = BUN 34 mg/dL R: Amphotericin B is nephrotoxic. Therefore, an elevated BUN and/or an elevated creatinine level can indicate renal impairment. The nurse should notify the provider of this result. 90. A nurse is preparing to administer amikacin 500 mg by intermittent IV bolus to a client. Available as amikacin 500 mg in dextrose 5% in water 200 mL to infuse over 30 minutes the nurse should set the Ivy pump to deliver how many I know mL/ hour? Round the answer to the nearest whole number. = 400 mL/hr [Show Less]

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