ATI Capstone Med Surg Questions & Answers
a nurse is reviewing the ABG results of a client who the provider suspects has
metabolic acidosis. what would the nurse expect to see
Correct ANS- pH below 7.35
a pt is experiencing SOB, fatigue, JVD, the nurse auscultates a third heart sound (S3),
what should the nurse anticipate as the cause of these s\/s
Correct ANS- HF
a nurse is administering potassium chloride elixer 40mEq divided into 2 equal doses
every 12 hours, available is 6.7 mEq\/5mL. how many mL should the nurse administer
per dose?
Correct ANS- 30mL
a nurse is caring for a pt in the ED who was just admitted with chest pain, possible
acute coronary syndrome. what should the nurse do first?
Correct ANS- administer sublingual nitroglycerin
(treat chest pain to reduce cardiac tissue damage)
a nurse is caring for pt who is experiencing ventricular tachycardia with a pulse, the
RRT is at the bedside. what electrical intervention should be used to correct this
dysrhythmia?
Correct ANS- synchronized cardioversion
(tx for afib, SVT, and v tach with a pulse)
a nurse is caring for an adult pt who is experiencing delayed wound healing, which of
the following interventions should the nurse take?
Correct ANS- monitor serum albumin levels and notify provider if below 3.5g\/dL
(lack of protein increases the risk for a delay in wound healing and infection)
a nurse is teaching a client who has pre-dialysis ESKD about diet, what should be
included?
Correct ANS- reduce intake of foods high in potassium
(potassium clearance is impaired in ESKD)
a nurse is caring for a client who has T1DM, the nurse misread the client’s morning BG
level as 210mg\/dL, instead of 120mg\/dL and administered the insulin dose appropriate
for a reading over 200mg\/dL before the client’s breakfast, what action is the nurse’s
priority? C
orrect ANS- monitor the client for hypoglycemia<\/p>\n\n\n\n
a nurse is planning care for a pt who has a new diagnosis of DI, which of the following
interventions should the nurse include in the plan of care?
Correct ANS- check urine specific gravity
a nurse is caring for a pt admitted with wheezing and coughing due to an allergic
reaction to a newly prescribed medication, what medication should be administered
first?
Correct ANS- albuterol 3mL via nebulizer
a nurse is caring for a female client in the ED who reports SOB and pain in the lung
area, she states that she started taking BC pills 3 weeks ago and that she smokes, her
heart rate is 110\/min, RR 40\/min, and BP 140\/80, her ABGs are pH 7.50, PaCO2 29,
PaO2 60, HCO3 20, SaO2 86%, what is the priority of nursing interventions
Correct ANS- administer oxygen via face mask
a nurse is caring for a pt following repair of a fracture, what finding should alert the
nurse that the pt is experiencing compartment syndrome?
Correct ANS- unrelieved pain, pallor, pulselessness, numbness, pins and needles
sensation, swelling, tightness of the effected extremity
a nurse is administering a tap water enema to a pt who is constipated, during the
administration of the enema, the client states he is having abdominal cramps, what
action should the nurse take to relieve the client’s comfort
Correct ANS- lower the height of the solution container
a pt is diagnosed with left homonymous hemianopsia following a stroke, what action
should the nurse take?
Correct ANS- place the clients bedside table on the right side of the bed
a nurse is caring for a pt who is at risk for shock, what finding is the earliest indicator
that this complication is developing?
Correct ANS- narrowing pulse pressure
a nurse is assessing a client who has hypokalemia as a result of n\/v, and diarrhea, what
finding should the nurse expect
Correct ANS- weak, irregular pulse
a nurse is providing teaching for a client who has experienced an acute episode of
gastritis, what instruction should the nurse include in the teaching?
Correct ANS- avoid drinking alcohol
a nurse at an outpt surgery center is providing discharge teaching to a pt an his spouse
following surgical removal of a cataract, what should the nurse include?
Correct ANS- the client should wear dark glasses while outdoors<\/p>\n","protected":false},"excerpt":{"rendered":"
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