ATI RN TEST BANK

ATI Capstone Medical Surgical Assessment 2 Quizlet

A nurse misreads a glucose reading and administers insulin for a blood glucose of 210 instead of 120. What should the nurse monitor the patient for?

    A. Monitor for hyperglycemia

    B. Monitor for signs of hypoglycemia

    C. Administer glucose IV

    D. Document the incident

Correct Answer: B
Rationale: The correct answer is B: Monitor for signs of hypoglycemia. The nurse should monitor the patient for hypoglycemia due to the administration of excess insulin. Administering insulin for a blood glucose level of 210 instead of 120 can lead to a rapid drop in blood sugar levels, causing hypoglycemia. Option A is incorrect as hyperglycemia is high blood sugar, which is unlikely in this scenario. Option C is incorrect as administering glucose IV would worsen the hypoglycemia. Option D is not the immediate priority; patient safety and monitoring for adverse effects take precedence.

What dietary recommendation should be given to a patient with GERD?

  • A. Avoid mint and spicy foods
  • B. Eat large meals before bedtime
  • C. Consume liquids with meals
  • D. Eat three large meals per day

Correct Answer: A
Rationale: The correct recommendation for a patient with GERD is to avoid mint and spicy foods. Mint and spicy foods can aggravate GERD symptoms by relaxing the lower esophageal sphincter and increasing stomach acid production, leading to acid reflux. Choices B, C, and D are incorrect. Eating large meals before bedtime can worsen GERD symptoms as lying down can promote acid reflux. Consuming liquids with meals can also exacerbate GERD by increasing stomach distension and pressure on the lower esophageal sphincter. Eating three large meals per day can overload the stomach and trigger acid reflux episodes in patients with GERD.

What intervention is needed for a patient with a chest tube and an air leak?

  • A. Tighten the connections of the chest tube system
  • B. Replace the chest tube
  • C. Clamp the chest tube
  • D. Continue to monitor the chest tube

Correct Answer: A
Rationale: The correct intervention for a patient with a chest tube and an air leak is to tighten the connections of the chest tube system. This step helps prevent air leaks and ensures the proper functioning of the chest tube. Choice B, replacing the chest tube, is not necessary as tightening the connections should be attempted first. Clamping the chest tube (Choice C) is not recommended as it can lead to complications by obstructing the drainage system. Continuing to monitor the chest tube (Choice D) without taking action may result in worsening of the air leak. Therefore, the priority intervention is to tighten the connections of the chest tube system.

A patient who experienced an acute episode of gastritis should avoid which type of foods?

  • A. Avoid foods high in potassium
  • B. Avoid foods high in sodium
  • C. Increase exercise
  • D. Drink milk as a snack

Correct Answer: A
Rationale: Patients who have experienced an acute episode of gastritis should avoid foods high in potassium. Potassium-rich foods can irritate the gastric lining, exacerbating gastritis symptoms. Therefore, choices B, C, and D are incorrect. Avoiding foods high in sodium is beneficial for other health conditions like hypertension, increasing exercise is generally good for overall health but not specifically for gastritis management, and drinking milk may provide temporary relief for some but is not a definitive recommendation for gastritis management.

What are the dietary instructions for a patient with pre-dialysis end-stage kidney disease?

  • A. Increase protein intake
  • B. Reduce sodium intake
  • C. Reduce potassium intake
  • D. Restrict protein intake to 0.55-0.60 g/kg/day

Correct Answer: D
Rationale: The correct answer is to restrict protein intake to 0.55-0.60 g/kg/day for a patient with pre-dialysis end-stage kidney disease. Excessive protein intake can worsen kidney function in such patients. Increasing protein intake, as mentioned in choice A, is not recommended due to the strain it puts on the kidneys. While reducing sodium intake, as in choice B, is relevant for managing blood pressure, it is not specifically related to pre-dialysis end-stage kidney disease. Choice C, reducing potassium intake, is important for patients with kidney disease, but it is not the primary dietary instruction for those with pre-dialysis end-stage kidney disease.

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