MED SURG ATI REVIEW

A nurse is providing teaching to a client who has type 2 diabetes mellitus about the pathophysiology of the disease. Which statement by the client indicates an understanding of the teaching?

"My cells are resistant to the effects of insulin" The client who has type 2 diabetes mellitus will have resistance to insulin and a decrease in the secretion of insulin by the pancreatic beta cells

A nurse is providing teaching to a client who has type 1 diabetes mellitus about exercise. Which of the following statement should the nurse include in the teaching?

"Wear a medical alert identification tag when you exercise" The client should wear a medical alert identification tag in the event of a hypoglycemic response, because exercise can potentiate the effects of insulin and cause the blood glucose levels to decrease

A nurse is providing teaching about lifestyle changes to a client who had a myocardial infarction and has a new prescription for a beta blocker. Which statement indicates an understanding of the teaching?

"before taking my medication, I will count my radial pulse rate" A beta blocker will induce bradycardia. The client should take her pulse rate for 1 min before self-administration.

A nurse is caring for a client who is in hypovolemic shock. While waiting for a unit of blood, the nurse should administer which IV solution?

0.9% sodium chloride (NS) Solutions of 0.9% sodium chloride, as well as Lactated Ringer's solution, are used for fluid volume replacement. Sodium chloride, a crystalloid, is a physiologic isotonic solution that replaces lost volume in the blood stream and is the only solution to use when infusing blood products.

A nurse is preparing to transfuse 250 mL of packed red blood cells (RBCs) to a client over 4 hr. Available is a blood administration set that delivers 10 gtt/ml. The nurse should set the manual blood transfusion to deliver how many gtt/min?

250 x 10 / 240 (240 is 4 hours in minutes) = 10.4 equation is dose x gtt divided by time in mins

A nurse is caring for a client who had a myocardial infarction 5 days ago. The client has a sudden onset of shortness of breath and begins coughing frothy, pink sputum. The nurse auscultates loud, bubbly sounds on inspiration. Which adventitious breath sounds should the nurse document?

Coarse crackles A client who had a recent myocardial infarction is at risk for left-sided heart failure. Crackles are breath sounds caused by movement of air through airways partially or intermittently occluded with fluid and are associated with heart failure and frothy sputum. Crackling sounds are heard at the end of inspiration and are not cleared by coughing.

a nurse is caring for a client who is postoperative following a bilateral adrenalectomy. The nurse should expect to administer glucocorticoids following the procedure to enhance which of the following therapeutic effects?

Compensate for decrease in cortisol levels The client who has an adrenalectomy requires glucocorticoids before, during, and after surgery to prevent an adrenal crisis caused by a sudden drop in cortisol levels. One of the hormones produced by the adrenal glands is cortisol, a glucocorticoid. Loss of glucocorticoid secretion leads to a state of altered metabolism and an inability to deal with stressors which, if untreated, is fatal.

A nurse is assessing a client who has right-sided HF. Which finding should the nurse expect?

Dependent edema Blood return from the venous system to the right atrium is impaired by a weakened right heart. The subsequent systemic venous backup leads to development of dependent edema.

A nurse is assessing a client who has pericarditis. Which manifestation should the nurse expect?

Dyspnea with hiccups The client who has pericarditis will experience dyspnea, hiccups, and a nonproductive cough. These manifestations can indicate heart failure from pericardial compression due to constrictive pericarditis or cardiac tamponade.

A nurse is checking lab values to determine if a client who has diabetes mellitus is adhering to the treatment plan. Which of the following tests should the nruse use to make the determination?

Glycosylated hemoglobin levels (HbA1c) Checking glycosylated hemoglobin levels, or HbA1c, is an accurate method to determine if the client is routinely compliant. Glycosylated hemoglobin refers to hemoglobin that is connected to glucose. Since the life span of an RBC is 4 months, this value will not be affected by recent changes in the client's diet or medication

A nurse is caring for a client who has type 2 diabetes mellitus and is displaying manifestations of hypergylcemia. Which of the following findings should indicate to the nurse that the client has hyperglycemia?

Increased urine (polyuria) Increased urination, or polyuria, is a manifestation of hyperglycemia due to a deficiency of insulin, which can lead to osmotic diuresis

A nurse is planning care for a client who has pernicious anemia. Which intervention should the nurse include in the plan?

Initiate weekly injections of vitamin B12 The nurse should initiate weekly injections of vitamin B12 for a client who has pernicious anemia, and then decrease to monthly. Pernicious anemia is caused by a lack of intrinsic factor needed to absorb vitamin B12 from the gastrointestinal tract.

A nurse is assessing a client who has fluid volume overload from a cardiovascular disorder. What manifestations should the nurse expect?

JVD, moist crackles, tachycardia The increase in venous pressure due to excessive circulating blood volume results in neck vein distension crackles are an indicator of pulmonary edema that can quickly lead to death Fluid volume excess, or hypervolemia, is an expansion of fluid volume in the extracellular fluid compartment. This results in increased heart rate and bounding pulses

A nurse is planning a community health screening for a group of clients who are at risk for type 2 diabetes mellitus. Which client should the nurse include in the screening?

Men and women who are obese. There is a high correlation between obesity and type 2 diabetes mellitus. Obesity plays a major role in the development of type 2 diabetes mellitus by decreasing the number of available insulin receptors in skeletal muscles and fat cells. This is referred to as peripheral insulin resistance. A reduced-calorie diet for obese clients tends to reverse the phenomenon of peripheral insulin resistance

A nurse is completing a medication history for a client who reports using fish oil as a dietary supplement. Which substance in fish oil should the nurse recognize as a health benefit to the client?

Omega-3 fatty acids Fish oil contains omega-3 fatty acids, which can help lower the risk of cardiovascular disease and stroke by decreasing triglyceride levels.

A nurse is caring for a client who is postoperative following vein ligation and stripping for varicose veins. Which action should the nurse take?

Position the client supine with legs elevated while in bed The nurse should elevate the client's legs above his heart to promote venous return by gravity. During discharge teaching, the nurse should reinforce the importance of periodic positioning of the legs above the heart

A nurse is caring for a client who has HF and whose telemetry reading displays a flattening of the T wave. Which of the following lab results should the nurse anticipate as the cause of this ECG change?

Potassium 2.8 mEq/L A flattened T wave or the development of U waves is indicative of a low potassium level

A nurse is transfusing a unit of B-positive fresh frozen plasma (FFP) to a client whose blood type is O-negative. Which action should the nurse take?

Remove the unit of plasma immediately and start an IV infusion of NS A client who receives FFP that is not compatible can experience a hemolytic transfusion reaction. The nurse should stop the transfusion and infuse 0.9% sodium chloride solution with new tubing.

A nurse is administering a unit of packed red blood cells (RBCs) to a client who is postoperative. The client reports itching and has hives 30 mins after the infusion begins. Which action should the nurse take?

Stop the infusion of blood The nurse should apply the urgent vs. nonurgent priority-setting framework. Using this framework, the nurse should consider urgent needs the priority because they pose more of a threat to the client. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, or nursing knowledge to identify which finding is the most urgent. The nurse should stop the infusion of blood because the client has manifestations of an allergic reaction.

A nurse is caring for a client who had a thyroidectomy to treat hyperthyroidism caused by an adenoma. Which of the following findings should the nurse report to the provider? (SATA)

Tachycardia and hypertension: Tachycardia and hypertension are unexpected findings, which can indicate the occurrence of thyroid storm following removal of the thyroid gland, especially if the client was in a hyperthyroid state prior to the surgery. Thyrotoxic, or thyroid storm, is a life-threatening condition with a sudden onset that includes tachycardia, fever, sweating, restlessness, and tremors. Congestive heart failure and pulmonary edema can develop rapidly and lead to death. laryngeal stridor and hoarseness: Laryngeal stridor and hoarseness are unexpected findings and can indicate swelling in the area of the surgery or damage to the laryngeal nerve. This should be reported to the provider before respiratory distress develops. positive trousseau's sign: A Positive Trousseau's sign is an indication of hypocalcemia, which is a complication of thyroid removal. This occurs when the parathyroid glands are also removed and regulation of serum calcium is impaired.

A nurse is caring for a client with a demand pacemaker inserted with the rate set at 72 bpm. Which finding should the nurse expect?

Telemetry monitoring shows QRS complexes occurring at a rate of 74 bpm with no pacing spikes The nurse should not expect pacer spikes when the client's pulse is greater than the set rate of 72/min, because the client's intrinsic rate overrides the set rate of the pacemaker.

A nurse is providing teaching to a client who has Addison's disease about healthy snack foods. Which of the following food choices by the client indicates an understanding of the teaching?

Turkey & cheese sandwich A turkey and cheese sandwich is high in protein, carbohydrates, and sodium. The client who has Addison's disease requires a diet low in potassium and high in sodium, carbohydrates, and protein. Addison's disease is a hormone deficiency caused by damage to the outer layer of the adrenal gland (adrenal cortex). Addison's disease occurs when the adrenal glands do not produce enough of the hormone cortisol and, in some cases, the hormone aldosterone

A nurse is preparing to transfuse a unit of packed red blood cells (RBCs) to a client who has anemia. Which action should the nurse take first?

Witness the informed consent The nurse should apply the least invasive priority-setting framework. This framework assigns priority to nursing interventions that are least invasive to the client, as long as those interventions do not jeopardize client safety. The nurse should take interventions that are not invasive to the client before interventions that are invasive; therefore, as witnessing the informed consent is the least invasive, it is the action that should be performed first. Unless it is an emergency, informed consent should be obtained prior to initiating a blood transfusion to a client.

A nurse is caring for a client who has an abdominal aortic aneurysm and is scheduled for surgery. The client's VS are BP 160/98, HR 102, RR 22, O2 95%, which action should the nurse take?

administer antihypertensive medication for blood pressure The nurse should administer antihypertensive medication for the elevated blood pressure because hypertension can cause a sudden rupture of the aneurysm due to pressure on the arterial wall.

A nurse on the telemetry unit is caring for a patient who has an irregular radial pulse. Which of the following ECG abnormalities should the nurse recognize as atrial flutter?

atrial rate of 300/ min with QRS complex of 80/min The nurse should interpret this finding as atrial flutter, which indicates a lack of conduction between the atria and ventricles. The additional atrial beats are not conducting

A nurse is assessing for cardiac tamponade on a client who had coronary artery bypass grafts. Which action should the nurse take?

auscultate blood pressure for pulsus paradoxus The client who has cardiac tamponade will have pulsus paradoxus when the systolic blood pressure is at least 10 mm Hg higher on expiration than on inspiration. This occurs because of the sudden decrease in cardiac output from the fluid compressing the atria and ventricles.

A nurse is reviewing lab values of a client who has diabetic ketoacidosis. The nurse should understand that which lab value is consistent with DKA?

bicarbonate level 12 mEq/L a client who has DKA should have. a bicarb level less than 15 mEq/L because the client has an increased production of counter regulatory hormones that lead to metabolic acidosis.

A nurse is assessing a client who has Addison's disease. Which of the following skin manifestations should the nurse expect to find?

bronze pigmentation of the skin The client who has Addison's disease will have a darkening of the skin in both exposed and unexposed parts of the body due to a hormone deficiency caused by damage to the outer layer of the adrenal gland (adrenal cortex).

A nurse is caring for a client who is postoperative following a parathyroidectomy to treat hyperparathyroidism. Which lab value should the nurse expect. to decrease as a therapeutic effect of the procedure?

calcium The parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the client's blood and bone by maintaining a balance between the mineral levels in the blood and the bone. Hyperparathyroidism is associated with hypercalcemia; therefore, a decrease in the calcium level indicates an improvement in the client's condition.

A nurse is planning care for a client who has cushing's syndrome due to chronic corticosteroid use. Which of the following actions should the nurse include in the plan of care?

check the client's urine specific gravity The nurse should check the client's urine specific gravity to assess for fluid volume overload.

A nurse is completing an assessment for a client who has a history of unstable angina. What findings should the nurse expect?

chest pain lasts longer than 15 minutes The client who has unstable angina will have chest pain lasting longer than 15 min. This is due to the reduced blood flow in a coronary artery due to atherosclerotic plaque and thrombus formation causing partial arterial obstruction, or from an artery spasm

A nurse is assessing a client who has Grave's Disease. Which findings should the nurse expect the client to display?

difficulty sleeping the client who has grave's disease can have difficulty sleeping and anxiety due to the overproduction of thyroid hormone

A nurse in a clinic is assessing the lower extremities and ankles of a client who has a history of peripheral artery disease. Which finding should the nurse expect?

dry, pale skin with minimal body hair A client who has peripheral arterial disease can display dry, scaly, pale, or mottled skin with minimal body hair because of narrowing of the arteries in the legs and feet. This causes a decrease in blood flow to the distal extremities, which can lead to tissue damage. Common manifestations are intermittent claudication (leg pain with exercise), cold or numb feet at rest, loss of hair on the lower legs, and weakened pulses.

A nurse is monitoring a client who has Grave's disease for the development of thyroid storm. The nurse should report which of the following findings to the provider?

hypertension The client who is experiencing a thyroid storm will have an exaggerated condition of hyperthyroidism associated with the development of fever, hypertension, abdominal pain, and tachycardia. Graves' disease is a common cause of hyperthyroidism, which is an imbalance of metabolism caused by overproduction of the thyroid hormone.

a nurse is providing teaching to a client who has anemia and a new prescription for epoetin alfa. Which information should the nurse include in the teaching?

hypertension is a common side effect of this medication The nurse should teach that a common adverse effect of epoetin alfa is hypertension because of the rise in the production of erythrocytes and other blood cell types. Epoetin alfa is a synthetic version of human erythropoietin. Epoetin alfa is used to treat anemia associated with kidney disease or medication therapy. It increases and maintains the red blood cell level.

A nurse is monitoring a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which finding should the nurse expect?

hyponatremia The client who has SIADH will have hyponatremia caused by the excessive release of an antidiuretic hormone (ADH). As a result of the excess ADH, the client retains water that causes dilutional hyponatremia.

A nurse is assessing a client who has manifestations of acromegaly. Which of the following findings should the nurse expect?

increased head size a client who has acromegaly will manifest an enlarged head size due to the excessive production of growth hormones after closing the epiphyses (the "growth plate" at the ends of the long bones) by the pituitary gland. It results in the gradual enlargement of the client's body tissues, such as the bones of the face, jaw, hands, feet and skull

A nurse is monitoring a client who has right-sided HF related to mitral stenosis. The client reports SOB on exertion. Which condition should the nurse expect?

increased pulmonary congestion Pulmonary congestion occurs due to right-sided heart failure. Because of the defect in the mitral valve, the left atrial pressure rises, the left atrium dilates, there is an increase in pulmonary artery pressure, and hypertrophy of the right ventricle occurs. In this case, dyspnea is an indication of pulmonary congestion and right-sided heart failure.

A nurse is reviewing the lab results of an adult client who has sickle cell anemia and a history of receiving blood transfusions. Which complication should the nurse monitor for?

iron toxicity The client who has received several blood transfusions is at risk for development of hemosiderosis, which is excess storage of iron in the body. The excessive iron can come from overuse of supplements or from receiving frequent blood transfusions, as in sickle cell anemia.

A nurse is assessing a client who has an abdominal aortic aneurysm. Which manifestation should the nurse expect?

lower back discomfort Abdominal aortic aneurysm involves a widening, stretching, or ballooning of the aorta. Back and abdominal pain indicate that the aneurysm is extending downward and pressing on lumbar spinal nerve roots, causing pain

A nurse is planning care for a client who is having a percutaneous transluminal coronary angioplasty (PTCA) with stent placement. Which action should the nurse anticipate in the postprocedure plan of care?

monitor for bleeding Bleeding is a post-procedure complication of PTCA because of the administration of heparin during the procedure and the removal of the femoral (or brachial) sheath. Manual pressure or a closure device is used to obtain hemostasis to the site. The client remains on bed rest until hemostasis is assured.

A nurse is planning care for a client who is experiencing the somogyi effect and takes intermittent acting insulin. Which of the following actions should the nurse include in the plan?

monitor the client's nighttime blood glucose levels The Somogyi effect is a swing of a high blood glucose level in the morning after an extremely low blood glucose level during the night. The swing is caused by the release of stress hormones to counter low glucose levels. Monitoring the client's nighttime blood glucose levels over time can provide an accurate diagnosis of the Somogyi effect.

a nurse is preparing to assist a provider to withdraw arterial blood from a client's radial artery for measurement of ABG. Which action should the nurse plan to take?

perform an Allen's test prior to obtaining the specimen The nurse should ensure that circulation to the hand is adequate from the ulnar artery in case the radial artery is injured from the blood draw. The most common site for withdrawal of arterial blood gases is the radial artery

a nurse is assessing a client for manifestations of aplastic anemia. Which findings should the nurse expect?

petechiae and ecchymosis The client who has aplastic anemia will have manifestations of petechiae and ecchymosis. Dyspnea on exertion also can be present. In aplastic anemia, all three major blood components (red blood cells, white blood cells, and platelets) are reduced or absent, which is known as pancytopenia. Manifestations usually develop gradually.

A nurse is caring for a client who has diabetes insipidus. For which of the following findings should the nurse monitor?

polyuria diabetes insipidus is characterized by increased thirst (polydipsia) and increased urination (polyuria). The client who has diabetes insipidus will excrete large quantities of urine with a very low specific gravity

A nurse is caring for a client who has hemophilia. The client reports pain and swelling in a joint following an injury. Which action should the nurse take?

prepare for replacement of the missing clotting factor Hemophilia is a hereditary bleeding disorder in which blood clots slowly and abnormal bleeding occurs. It is caused by a deficiency in the most common clotting factor, factor VIII (hemophilia A). Aggressive factor replacement is initiated to prevent hemarthrosis that can result in long-term loss of range of motion in repeatedly affected joints.

A nurse is providing instructions about the pursed lip-breathing for a client who has COPD with emphysema. The nurse should explain that this breathing technique accomplishes which of the following?

promotes carbon dioxide elimination the client who has COPD with emphysema should use pursed lip breathing when experiencing dyspnea. This is one of the simplest ways to control dyspnea. It slows the client's pace of breathing, making each breath more effective. Pursed-lip breathing releases trapped air in the lungs and prolongs exhalation to slow the breathing rate. This improved breathing pattern moves carbon dioxide out of the lungs more efficiently.

A nurse is reviewing a client's repeat lab results 4 hours after administering fresh frozen plasma (FFP). Which lab results should the nurse review?

prothrombin time the nurse should review the client's prothrombin time after the administration of FFP, which is plasma rich in clotting factors. FFP is administered to treat acute clotting disorders. The desired effect is a decrease in the prothrombin time.

A nurse is caring for an older adult client who has chronic obstructive pulmonary disease with pneumonia. The nurse should monitor the client for which of the following acid base balances?

respiratory acidosis respiratory acidosis is a common complication of COPD. This complication occurs because clients who have COPD are unable to exhale carbon dioxide due to a loss of elastic recoil in the lungs

a nurse is providing teaching to a client who has type 1 diabetes mellitus about hypoglycemia. Which of the following manifestations should the nurse include in the teaching?

shakiness a client who has hypoglycemia can experience early manifestations of shakiness. Other early manifestations include fatigue, headache, difficulty thinking, sweating and nausea.

A nurse is preparing to administer cisplatin IV to a client who has lung cancer. The nurse should identify that which of the following findings is an adverse effect of this medication?

tinnitus an adverse effect o cisplatin is ototoxicity, which can cause tinnitus

A nurse is preparing a 24-hour urine specimen for a client who is suspected to have pheochromocytoma. Which of the following lab tests from the 24-hour urine specimen should the nurse use to determine client's condition?

vanillylmandelic acid (VMA) The nurse should expect the 24-hr urine specimen to test for VMA. This test is used to determine if the client has pheochromocytoma, which measures the level of catecholamine metabolites in a 24-hr urine sample. Pheochromocytoma is a tumor of the adrenal gland that causes excess release of the catecholamines epinephrine and norepinephrine, which are hormones that regulate blood pressure and heart rate.

A nurse is monitoring a client who had a myocardial infarction. What complication should the nurse monitor for in the next 24 hours?

ventricular dysrhythmias After a myocardial infarction, the electrical conduction system of the heart can be irritable and prone to dysrhythmias. Ischemic tissue caused by the infarction can also interfere with the normal conduction patterns of the heart's electrical system

A nurse is assessing a client who has late-stage HF and is experiencing fluid volume overload. Which finding should the nurse expect?

weight gain of 1 kg (2.2 lbs) in one day A weight gain of 1 kg (2.2 lb) in 1 day alerts the nurse that the client is retaining fluid and is at risk of fluid volume overload. This is an indication that the client's heart failure is worsening.