ATI RN
Multi Dimensional Care | Exam | Rasmusson
1. The nurse is providing education to a client regarding the administration of eye drops. Which of the following actions indicates the need for further client education?
- A. The client instills the prescribed number of eye drops into the conjunctival sac
- B. The client sets the cap to the eye drop container down in a manner that does not contaminate it
- C. The client touches the administration dropper her to the eye
- D. The client washes her hands before instilling the eye drops
Correct answer: The client touches the administration dropper her to the eye
Rationale:
2. A patient who is hospitalized with a possible electrolyte imbalance is disoriented and weak, has an irregular pulse, and takes hydrochlorothiazide. He most likely suffers from:
- A. Hypernatremia
- B. Hyponatremia
- C. Hyperkalemia
- D. Hypokalemia
Correct answer: D
Rationale: The patient is displaying symptoms of hypokalemia, including weakness, disorientation, irregular pulse, which can lead to cardiac disturbances. Hydrochlorothiazide is a potassium-wasting diuretic that can cause hypokalemia if not accompanied by potassium replacement therapy. Hypernatremia (choice A) is characterized by high sodium levels, not potassium. Hyponatremia (choice B) is low sodium levels. Hyperkalemia (choice C) is high potassium levels, which is not consistent with the symptoms described in the question.
3. Which enzyme digests fiber in the large intestine?
- A. salivary amylase
- B. pancreatic amylase
- C. cellulase
- D. none of the above
Correct answer: D
Rationale: The correct answer is 'none of the above.' Human digestive enzymes like salivary amylase and pancreatic amylase cannot digest fiber. Instead, fiber is fermented by gut bacteria in the large intestine. Cellulase, which is an enzyme produced by some animals and microorganisms, can break down cellulose found in plants, but it is not a human digestive enzyme, making it an incorrect choice in this context.
4. A nurse is reviewing the laboratory report of a client who has been receiving lithium carbonate for the past 12 months. The nurse notes a lithium level of 0.8 mEq/L. Which of the following orders from the provider should the nurse expect?
- A. Withhold the next dose.
- B. Increase the dosage.
- C. Discontinue the medication.
- D. Administer the medication.
Correct answer: D
Rationale: Administering the medication is appropriate for a stable lithium level of 0.8 mEq/L. A level of 0.8 mEq/L falls within the therapeutic range for lithium, indicating that the client is receiving an adequate dose to maintain therapeutic effects. Withholding the next dose, increasing the dosage, or discontinuing the medication would not be indicated at this lithium level as it is within the desired range for therapeutic benefit. Therefore, the correct action would be to continue administering the medication to ensure the client maintains the therapeutic level of lithium.
5. A nurse is caring for a client who has Cushing's syndrome. Which of the following findings should the nurse expect?
- A. Hypotension.
- B. Weight loss.
- C. Hyperkalemia.
- D. Hypercalcemia.
Correct answer: C
Rationale: In clients with Cushing's syndrome, the nurse should expect hyperkalemia. Cushing's syndrome is characterized by excess cortisol levels, which can lead to potassium retention and result in hyperkalemia. Choices A, B, and D are incorrect. Hypotension is not typically associated with Cushing's syndrome; instead, hypertension is more common due to the effects of cortisol. Weight gain, rather than weight loss, is a common symptom of Cushing's syndrome. Hypercalcemia is not a typical finding in Cushing's syndrome; instead, hypocalcemia may occur due to increased urinary calcium excretion.
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