ATI RN
ATI Medical Surgical Proctored Exam
1. A client is on intravenous heparin to treat a pulmonary embolism. The client's most recent partial thromboplastin time (PTT) was 25 seconds. What action should the nurse anticipate?
- A. Decrease the heparin rate.
- B. Increase the heparin rate.
- C. No change to the heparin rate.
- D. Stop the heparin; start warfarin (Coumadin).
Correct answer: B
Rationale: For clients on heparin therapy, a PTT value of 1.5 to 2.5 times the normal range is required to ensure therapeutic anticoagulation. The normal PTT range is 25 to 35 seconds. In this case, the client's PTT of 25 seconds falls below the therapeutic range, indicating that the heparin dose is insufficient. Therefore, the nurse should anticipate increasing the heparin rate to achieve the desired therapeutic effect.
2. A patient is prescribed testosterone gel for hypogonadism. What important instruction should the nurse provide regarding the application of this medication?
- A. Apply the gel to the chest or upper arms.
- B. Apply the gel to the face and neck.
- C. Apply the gel to the genitals for maximum absorption.
- D. Apply the gel to the scalp and back.
Correct answer: A
Rationale: The correct answer is to apply the testosterone gel to the chest or upper arms. This is recommended to minimize the risk of unintentional transfer of the medication to others, especially women and children, through skin contact. Applying the gel to the face, neck, or genitals is not advised as it can lead to unintended exposure to others. Additionally, applying the gel to the scalp or back is not appropriate as these areas are not indicated for absorption of testosterone.
3. Each statement is true of calcium within saliva, except one. Which is the exception?
- A. Saliva is supersaturated with calcium.
- B. Saliva is a source of calcium to mineralize an immature or demineralized enamel surface.
- C. Calcium and phosphate in saliva provide a buffering action.
- D. Calcium within saliva increases dental caries.
Correct answer: D
Rationale: The correct answer is D. Calcium within saliva does not increase dental caries; in fact, the buffering action provided by calcium and phosphate in saliva inhibits caries formation by preventing the dissolution of enamel by plaque biofilm. Choice A is correct as saliva is indeed supersaturated with calcium. Choice B is correct as saliva serves as a source of calcium to mineralize an immature or demineralized enamel surface. Choice C is correct as calcium and phosphate in saliva do provide a buffering action to protect teeth from acids.
4. In what significant way should the therapeutic environment differ for a client who has ingested LSD from that of a client who has ingested PCP?
- A. For LSD ingestion, maintain a regimen of limited interaction and minimal verbal stimulation. For PCP ingestion, place client on one-on-one intensive supervision.
- B. For LSD ingestion, place the client in restraints. For PCP ingestion, place the client on seizure precautions.
- C. For LSD ingestion, provide continual medieval simulation involving as many senses as possible. For PCP ingestion, provide continual high-level stimulation.
- D. For PCP ingestion, place the client on one-on-one intensive supervision. For LSD ingestion, maintain a regimen of limited interaction and minimal verbal stimulation.
Correct answer: For PCP ingestion, place client on one-on-one intensive supervision. For LSD ingestion, maintain a regimen of limited interaction and minimal verbal stimulation.
Rationale: When managing a client who has ingested PCP, it is crucial to provide one-on-one intensive supervision to ensure their safety and prevent any harm to themselves or others. This level of supervision is necessary due to the unpredictable and potentially dangerous effects of PCP. On the other hand, for a client who has ingested LSD, it is recommended to maintain a calm environment with limited interaction and minimal verbal stimulation. This approach aims to prevent exacerbating any adverse effects of LSD, such as anxiety or paranoia, by reducing external stimuli. Therefore, the correct approach is to provide one-on-one intensive supervision for PCP ingestion and limit interaction and verbal stimulation for LSD ingestion.
5. A healthcare professional is assessing a patient with pneumonia. Which finding is most concerning?
- A. Fever of 101°F.
- B. Blood pressure of 140/90 mmHg.
- C. Heart rate of 95 beats per minute.
- D. Crackles heard in the lung bases.
Correct answer: D
Rationale: Crackles heard in the lung bases are most concerning in a patient with pneumonia as they suggest fluid accumulation in the lungs, indicating possible severe infection or respiratory distress. Prompt intervention is required to prevent further complications.\n\nChoice A, fever of 101°F, is common in infections like pneumonia but may not be as immediately concerning as crackles indicating fluid in the lungs.\n\nChoice B, a blood pressure of 140/90 mmHg, is within normal limits and not directly indicative of pneumonia severity.\n\nChoice C, a heart rate of 95 beats per minute, is slightly elevated but not as critical as crackles suggesting fluid in the lungs.
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