ATI LPN
Adult Medical Surgical ATI
1. A 45-year-old man with a history of chronic heartburn presents with progressive difficulty swallowing solids and liquids. He has lost 10 pounds in the past two months. What is the most likely diagnosis?
- A. Esophageal stricture
- B. Esophageal cancer
- C. Achalasia
- D. Peptic ulcer disease
Correct answer: B
Rationale: In this scenario, the patient's presentation of progressive dysphagia to both solids and liquids, along with significant weight loss, is concerning for esophageal cancer. The history of chronic heartburn further raises suspicion as chronic gastroesophageal reflux disease is a risk factor for the development of esophageal adenocarcinoma. Esophageal stricture could cause dysphagia but is less likely to be associated with significant weight loss. Achalasia typically presents with dysphagia to solids more than liquids and does not commonly cause weight loss. Peptic ulcer disease is less likely to lead to progressive dysphagia and significant weight loss compared to esophageal cancer.
2. The client with deep vein thrombosis (DVT) is receiving anticoagulant therapy. Which laboratory test should the nurse monitor to evaluate the effectiveness of the therapy?
- A. Complete blood count (CBC)
- B. Activated partial thromboplastin time (aPTT)
- C. Serum electrolytes
- D. Liver function tests
Correct answer: B
Rationale: Activated partial thromboplastin time (aPTT) is the correct laboratory test to monitor the effectiveness of anticoagulant therapy, especially with heparin. A prolonged aPTT indicates effective anticoagulation, reducing the risk of further clot formation in the client with deep vein thrombosis (DVT). The other options, such as complete blood count (CBC), serum electrolytes, and liver function tests, do not directly assess the therapeutic effectiveness of anticoagulant therapy. Therefore, the correct answer is B.
3. A client has a new prescription for prednisone. Which of the following statements should the nurse include in teaching the client?
- A. You may experience weight gain.
- B. Increase your intake of vitamin K.
- C. Expect increased urinary output.
- D. You may have dark, tarry stools.
Correct answer: A
Rationale: The correct answer is A. Weight gain is a common side effect of prednisone. The nurse should educate the client about the possibility of weight gain and the need to monitor it closely during treatment with prednisone. Choice B is incorrect because increasing vitamin K intake is not specifically related to prednisone therapy. Choice C is incorrect as prednisone is more likely to cause fluid retention rather than increased urinary output. Choice D is incorrect as dark, tarry stools are not a common side effect of prednisone.
4. A client has been prescribed trazodone. Which of the following should be monitored?
- A. Blood glucose levels
- B. Liver function
- C. Mood changes
- D. Heart rate
Correct answer: C
Rationale: Correct. Trazodone is an antidepressant that can impact mood and behavior. Monitoring for changes in mood or behavior is crucial to assess the effectiveness and potential side effects of the medication. Monitoring blood glucose levels is not typically associated with trazodone use. While trazodone can affect liver function in some cases, monitoring liver function is not the primary concern compared to assessing mood changes. Trazodone can cause changes in heart rate in some patients, but the priority monitoring in this case should be related to its effects on mood.
5. An adolescent patient seeks care in the emergency department after sharing needles for heroin injection with a friend who has hepatitis B. To provide immediate protection from infection, what medication will the nurse administer?
- A. Corticosteroids
- B. Gamma globulin
- C. Hepatitis B vaccine
- D. Fresh frozen plasma
Correct answer: B
Rationale: In this scenario, the immediate need is to provide passive immunity to the adolescent patient. Gamma globulin contains antibodies against hepatitis B, which can offer immediate protection. The hepatitis B vaccine provides active immunity over time but is not immediate. Fresh frozen plasma and corticosteroids are not indicated for immediate protection against hepatitis B infection. Therefore, the correct choice is Gamma globulin as it can provide immediate passive immunity against hepatitis B.
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