ATI LPN
Adult Medical Surgical ATI
1. A 68-year-old man with a history of diabetes, hypertension, and coronary artery disease (s/p coronary artery bypass graft two years ago) presents to the emergency room with fevers and left-sided abdominal pain. His physical examination reveals a temperature of 101.5°F, pulse 96, and blood pressure of 135/80. His abdomen is soft with moderate left lower quadrant tenderness. There is no rebound or guarding. Bowel sounds are present. A CT scan is done which reveals inflammation around an area of the left colon. The next step in his workup/management should be
- A. Antibiotic therapy with ciprofloxacin and metronidazole
- B. Referral for urgent colonoscopy
- C. Referral to a surgeon for immediate hemicolectomy
- D. Barium enema
Correct answer: A
Rationale: The patient's presentation is consistent with diverticulitis without evidence of perforation or abscess formation on CT scan. During acute infections, procedures like barium enema and colonoscopy should be avoided to prevent the risk of perforation. Urgent surgery is not indicated initially. The appropriate next step is to start antibiotic therapy aimed at gram-negative aerobes and anaerobes, such as ciprofloxacin and metronidazole, which are the initial treatment of choice for diverticulitis.
2. A nurse is providing teaching to a newly licensed nurse about metoclopramide. The nurse should include in the teaching that which of the following conditions is a contraindication to this medication?
- A. Hyperthyroidism
- B. Intestinal obstruction
- C. Glaucoma
- D. Low blood pressure
Correct answer: B
Rationale: The correct answer is B: Intestinal obstruction. Metoclopramide is contraindicated in clients with intestinal obstruction due to its prokinetic effects, which could exacerbate the condition. Choices A, C, and D are incorrect because metoclopramide is not contraindicated in hyperthyroidism, glaucoma, or low blood pressure. Hyperthyroidism, glaucoma, and low blood pressure are not specific contraindications for metoclopramide use, and this medication is commonly prescribed for conditions like gastroesophageal reflux disease and diabetic gastroparesis.
3. A nurse is performing a health history on a client who identifies as Native American/First Nations. Based on familial history and racial disparities, for which health issue should the nurse prepare to monitor in this client?
- A. autoimmune disorders
- B. heart disease
- C. Alzheimer's disease
- D. lung cancer
Correct answer: B
Rationale: The correct answer is B: heart disease. Heart disease is a major health issue among Native American/First Nations populations, along with diabetes, malignant neoplasm, and unintentional injuries, contributing to a decreased lifespan. Autoimmune disorders, Alzheimer's disease, and lung cancer are not the primary health concerns that the nurse should monitor for in this client. By understanding the prevalent health issues in this population, the nurse can provide targeted care and interventions to promote better health outcomes.
4. A client with a serum albumin level of 3 g/dL has a pressure ulcer. What should the nurse do first?
- A. Monitor the client's fluid and electrolyte balance
- B. Consult a dietitian to improve the client's nutritional status
- C. Administer a protein supplement
- D. Administer an anti-inflammatory medication
Correct answer: B
Rationale: The correct first action for a client with a serum albumin level of 3 g/dL and a pressure ulcer is to consult a dietitian to improve the client's nutritional status. Adequate nutrition is essential for wound healing. Monitoring fluid and electrolyte balance is important but not the first priority in this situation. Administering a protein supplement can be considered after dietary evaluation. Administering an anti-inflammatory medication is not the primary intervention for addressing a pressure ulcer related to low albumin levels.
5. How should a healthcare provider assess a patient with potential diabetic ketoacidosis (DKA)?
- A. Monitor blood glucose and check for ketones in urine
- B. Administer insulin and provide fluids
- C. Administer potassium and check for electrolyte imbalance
- D. Administer sodium bicarbonate and monitor urine output
Correct answer: A
Rationale: Correct answer: To assess a patient with potential diabetic ketoacidosis (DKA), healthcare providers should monitor blood glucose and check for ketones in the urine. Elevated blood glucose levels and the presence of ketones in urine are indicative of DKA. Choice B is incorrect because administering insulin and providing fluids are treatments for DKA rather than assessment measures. Choice C is incorrect as administering potassium and checking for electrolyte imbalance are interventions related to managing DKA complications, not initial assessment. Choice D is incorrect because administering sodium bicarbonate and monitoring urine output are not primary assessment actions for DKA.
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