ATI RN
ATI Capstone Medical Surgical Assessment 1 Quizlet
1. A patient with pre-dialysis end-stage kidney disease is asking for dietary recommendations. What should the nurse suggest?
- A. Limit protein intake
- B. Limit potassium intake
- C. Restrict sodium intake
- D. Limit phosphorus intake to 700mg/day
Correct answer: D
Rationale: In patients with pre-dialysis end-stage kidney disease, it is crucial to limit phosphorus intake to 700mg/day to manage their condition. High phosphorus levels can lead to complications such as bone and heart problems. Limiting protein intake is essential in later stages of kidney disease, particularly in dialysis patients to reduce the buildup of waste products. While limiting potassium and restricting sodium intake are also important in kidney disease management, the priority for a patient with pre-dialysis end-stage kidney disease is to control phosphorus levels.
2. What is the most likely cause of continuous bubbling in the water seal chamber of a chest tube?
- A. An air leak
- B. A blockage in the chest tube
- C. Normal chest tube function
- D. Drainage from the chest tube
Correct answer: A
Rationale: Continuous bubbling in the water seal chamber of a chest tube usually indicates an air leak. An air leak can disrupt the negative pressure required for the chest tube to function properly, leading to inadequate drainage and potential complications. A blockage in the chest tube would typically result in decreased or absent drainage rather than continuous bubbling. Normal chest tube function does not involve continuous bubbling in the water seal chamber. Drainage from the chest tube may lead to fluid moving into the drainage system, but it would not cause continuous bubbling in the water seal chamber.
3. What dietary instructions should be provided for a patient with pre-dialysis end-stage kidney disease?
- A. Limit phosphorus intake to 700 mg/day
- B. Increase protein intake to 1g/kg/day
- C. Increase sodium intake
- D. Avoid potassium-rich foods
Correct answer: A
Rationale: Patients with pre-dialysis end-stage kidney disease should limit phosphorus intake to manage their condition. Excessive phosphorus can lead to mineral and bone disorders in patients with kidney disease. Choices B, C, and D are incorrect. Increasing protein intake is not recommended as it can burden the kidneys. Increasing sodium intake is usually discouraged due to its association with hypertension and fluid retention in kidney disease. Avoiding potassium-rich foods is more relevant in advanced kidney disease stages when potassium levels are high, not in pre-dialysis end-stage kidney disease.
4. 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.
5. A nurse is planning care for a group of postoperative clients. Which of the following interventions should the nurse identify as the priority?
- A. Administer IV pain medication to a client who reports pain as a 6 on a scale of 0 to 10
- B. Administer oxygen to a client who has an oxygen saturation of 91%
- C. Instruct a client who is 1 hr postoperative about coughing and deep breathing exercises
- D. Initiate an infusion of 0.9% sodium chloride for a client who has just had abdominal surgery
Correct answer: B
Rationale: The priority intervention is administering oxygen. Postoperatively, the client's oxygen saturation should be at or above 95%. Oxygen is essential for tissue perfusion and cellular oxygenation. While managing pain is important, oxygenation takes precedence. Instructing a client about coughing and deep breathing exercises is important for preventing respiratory complications but is not as urgent as addressing low oxygen saturation. Initiating an infusion of 0.9% sodium chloride is a routine postoperative intervention for fluid balance but is not the priority when oxygen saturation is low.
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