ATI RN
Cardiovascular System Exam
1. When administering enoxaparin (Lovenox) to a client, what is the most important lab value to monitor?
- A. Platelet count
- B. aPTT
- C. Hemoglobin
- D. INR
Correct answer: A
Rationale: The correct answer is A: Platelet count. When administering enoxaparin (Lovenox), it is crucial to monitor the platelet count because enoxaparin can cause a rare but serious side effect known as heparin-induced thrombocytopenia, which is a decrease in platelet count that can lead to increased risk of bleeding. Monitoring the platelet count allows for early detection of this potential complication. Choices B, C, and D are incorrect because aPTT, Hemoglobin, and INR are not the most important lab values to monitor specifically when administering enoxaparin.
2. A nurse is completing an admission assessment on an adolescent client who is a vegetarian. He eats milk products but does not like beans. Which of the following items should the nurse suggest the client order for lunch to provide the nutrients most likely to be lacking in his diet?
- A. Peanut butter and jelly sandwich
- B. Baked potato topped with sour cream
- C. Bagel with cream cheese
- D. Fruit salad
Correct answer: Fruit salad
Rationale: The correct answer is 'Fruit salad.' Since the adolescent client is a vegetarian who eats milk products but does not like beans, suggesting a fruit salad for lunch would provide essential nutrients like vitamins, minerals, and fiber that are commonly found in fruits. Fruit salad can help supplement the nutrients that may be lacking in his diet. Choices A, B, and C do not offer the same variety and quantity of nutrients as a fruit salad, making them less optimal choices for meeting the client's dietary needs.
3. What is the most sensitive indicator of altered brain function?
- A. The ability to perform complex mathematics
- B. Altered level of consciousness
- C. The lack of cerebrospinal fluid production
- D. Intact cranial nerve functions
Correct answer: B
Rationale: The correct answer is B: Altered level of consciousness. Changes in consciousness are the most sensitive indicator of altered brain function as they can signal underlying neurological issues. Option A, the ability to perform complex mathematics, though it involves brain function, is not as sensitive or direct an indicator as altered consciousness. Option C, the lack of cerebrospinal fluid production, is more related to conditions like hydrocephalus rather than a direct indicator of altered brain function. Option D, intact cranial nerve functions, indicate the normal functioning of peripheral nerves and are not as sensitive to changes in brain function as alterations in consciousness.
4. What is the most common cause of abdominal pain in school-aged children?
- A. Gastroenteritis
- B. Constipation
- C. Appendicitis
- D. Irritable bowel syndrome
Correct answer: B
Rationale: Constipation is the most common cause of abdominal pain in school-aged children. It is often due to dietary factors such as low fiber intake or insufficient fluid consumption. Chronic constipation can lead to complications like fecal impaction and soiling, highlighting the importance of early recognition and treatment. Gastroenteritis, although common, typically presents with diarrhea and vomiting. Appendicitis is more common in adolescents and typically presents with right lower quadrant pain. Irritable bowel syndrome is less common in children and is characterized by recurrent abdominal pain associated with defecation.
5. A client is following Seventh-Day Adventist dietary laws. Which of the following dietary guidelines should the nurse include in the plan of care?
- A. Replace salt with pepper when seasoning food.
- B. Request that coffee is removed from meal trays.
- C. Offer pork with two meals per week.
- D. Provide a high-protein snack between meals.
Correct answer: B
Rationale: Seventh-Day Adventists typically avoid stimulants like caffeine, so requesting that coffee be removed from meal trays is appropriate. Choice A is incorrect because it does not specifically relate to Seventh-Day Adventist dietary guidelines. Choice C is incorrect as pork is generally avoided in Seventh-Day Adventist dietary laws. Choice D is incorrect as it does not address the specific dietary preferences of Seventh-Day Adventist clients.
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