a nurse misreads a glucose level and administers insulin what is the priority intervention
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ATI Capstone Medical Surgical Assessment 2 Quizlet

1. After a healthcare provider misreads a glucose level and administers insulin, what is the priority intervention?

Correct answer: A

Rationale: The correct answer is to monitor for hypoglycemia. Administering insulin based on a misread glucose level can lead to hypoglycemia. Monitoring for hypoglycemia is crucial as it is a potential adverse effect of the insulin administration. Administering glucose IV (Choice B) is not the priority as there is no indication of hypoglycemia yet. Documenting the incident (Choice C) is important but not the immediate priority over patient safety. Monitoring for hyperglycemia (Choice D) is not the priority after administering insulin in response to a misread glucose level.

2. What ECG changes are expected in hypokalemia?

Correct answer: A

Rationale: In hypokalemia, flattened T waves are a common ECG finding due to the decreased extracellular potassium affecting repolarization. Prominent U waves are typically seen in hypokalemia as well, but flattened T waves are the more specific and early ECG change. Widened QRS complexes are associated with hyperkalemia, not hypokalemia. ST elevation is often seen in conditions like myocardial infarction, pericarditis, or early repolarization syndrome, not specifically in hypokalemia.

3. What is the first action a healthcare provider should take for a patient with possible acute coronary syndrome?

Correct answer: A

Rationale: Administering sublingual nitroglycerin is the initial priority action for a patient with possible acute coronary syndrome. Nitroglycerin helps dilate blood vessels, reduce chest pain, and improve blood flow to the heart muscle. This helps in relieving symptoms and preventing further damage to the heart. Establishing IV access, auscultating heart sounds, and obtaining cardiac enzymes are important steps in the assessment and management of acute coronary syndrome but are not the first actions to be taken. IV access may be needed for administering medications or fluids, auscultating heart sounds helps in assessing the heart's function, and obtaining cardiac enzymes aids in diagnosing a heart attack.

4. A nurse is caring for a client who has a peripherally inserted central catheter (PICC). For which of the following findings should the nurse notify the provider?

Correct answer: B

Rationale: An increase in the circumference of the client's upper arm by 10% could indicate deep vein thrombosis, which is a serious condition. Deep vein thrombosis can impede blood flow and potentially lead to life-threatening complications. Therefore, the nurse should notify the provider immediately about this finding. Choice A is not an immediate concern as PICC dressing changes are usually done every 7 days. Choice C is a normal finding as catheters may not be used for certain periods. Choice D is a correct procedure for maintaining catheter patency after medication use.

5. When providing discharge teaching to a patient who underwent cataract surgery, what should the patient avoid?

Correct answer: A

Rationale: The correct answer is to avoid NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can increase the risk of bleeding after cataract surgery due to their anticoagulant properties. Bright lights (choice B) are not contraindicated post-cataract surgery unless the patient experiences discomfort or sensitivity. Alcohol consumption (choice C) is generally not restricted after cataract surgery, but moderation is recommended. Phosphorus-rich foods (choice D) are not directly related to cataract surgery postoperative care.

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