ATI RN
ATI Capstone Adult Medical Surgical Assessment 1
1. A nurse is preparing to discharge a client who has a new diagnosis of chronic kidney disease (CKD). Which of the following referrals should the nurse plan to initiate?
- A. Respiratory therapy
- B. Hospice care
- C. Occupational therapy
- D. Dietary services
Correct answer: D
Rationale: The correct answer is D: Dietary services. Referring the client to dietary services is essential for managing nutrition, including monitoring sodium, potassium, and protein intake, which are crucial aspects of managing chronic kidney disease (CKD). Respiratory therapy (choice A) focuses on managing respiratory conditions, which are not directly related to CKD. Hospice care (choice B) is not appropriate for a new diagnosis of CKD as it is designed for end-of-life care. Occupational therapy (choice C) is beneficial for improving activities of daily living but is not the priority referral for a new CKD diagnosis.
2. What is the primary concern in a patient with a low CD4 T-cell count in HIV?
- A. Increased risk of infection
- B. Increased risk of bleeding
- C. Decreased immunity leading to opportunistic infections
- D. Increased risk of cardiac complications
Correct answer: A
Rationale: The correct answer is A: Increased risk of infection. In HIV patients with a low CD4 T-cell count, the primary concern is the increased susceptibility to infections due to compromised immunity. This compromised immune system can lead to various infections, making infection control crucial. Choice B, increased risk of bleeding, is not directly associated with a low CD4 count in HIV. Option C, decreased immunity leading to opportunistic infections, conveys a similar concern as the correct answer but lacks specificity. Choice D, increased risk of cardiac complications, is not typically the primary concern in HIV patients with a low CD4 count, as infections and opportunistic diseases pose more immediate threats to health.
3. Hepatic encephalopathy develops when the blood level of which substance increases?
- A. Ammonia
- B. Amylase
- C. Calcium
- D. Potassium
Correct answer: A
Rationale: Hepatic encephalopathy develops when the blood level of ammonia increases.
4. A client has a new prescription for Amlodipine. Which of the following instructions should the nurse include during discharge teaching?
- A. Take the medication at bedtime.
- B. Avoid drinking grapefruit juice.
- C. Increase your intake of high-sodium foods.
- D. Expect a dry cough.
Correct answer: B
Rationale: The correct instruction for the nurse to include during discharge teaching is to advise the client to avoid drinking grapefruit juice. Grapefruit juice can inhibit the metabolism of amlodipine, a calcium channel blocker, leading to increased drug levels in the blood. This can result in potentiated side effects and potential toxicity. Option A is incorrect as amlodipine is usually taken once daily, not specifically at bedtime. Option C is incorrect because high-sodium foods are generally discouraged in individuals with hypertension. Option D is incorrect as a dry cough is not an expected side effect of amlodipine.
5. A nurse is assessing a client who is experiencing auditory hallucinations. What question should the nurse ask?
- A. Do you understand the voices are not real?
- B. Why do you think the voices are talking to you?
- C. Have you tried going to a quiet place when this occurs?
- D. What helps you ignore the voices?
Correct answer: D
Rationale: Exploring strategies to ignore the hallucinations can help clients manage symptoms.
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