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ATI RN MED SURG PROTOCORED EXAM/ RECENT VERSION 2024| 210 QUESTIONS AND CORRECT ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |GRADED A+ $29.49
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ATI RN MED SURG PROTOCORED EXAM/ RECENT VERSION
2024| 210 QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |GRADED A+
An older adult is brought to an emergency department by a family member. Which
of the following assessment findings should cause the nurse to suspect that the
client has hypertonic dehydration? - ANSWER: Urine Specific gravity 1.045
A urine specific gravity greater than 1.030 indicates a decrease in urine volume and
an increase in osmolarity, which is a manifestation of hypertonic dehydration.
A nurse in a community clinic is caring for a client who reports an increase in the
frequency of migraine headaches. To help reduce the risk for migraine headaches,
which of the following foods should the nurse recommend the client avoid? -
ANSWER: Aged cheese
Foods that contain tyramine, such as aged cheese and sausage, can trigger migraine
headaches.
A nurse is planning teaching for a client who has bladder cancer and is to undergo
a cutaneous diversion procedure to establish a ureterostomy. Which of the
following statements should the nurse include in the teaching? - ANSWER: "You
should cut the opening of the skin barrier one-eight inch wider than the stoma."
The client should cut the opening of the skin barrier 0.3 cm (1/8in) wider than the
stoma to minimize irritation of the skin from exposure to urine.
A nurse is providing teaching to a client who has hypothyroidism and is receiving
levothyroxine. The nurse should instruct the client that which of the following
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supplements can interfere with the effectiveness of the medication? - ANSWER:
Calcium
Calcium limits the development of osteoporosis in clients who are postmenopausal
and works as an antacid. Calcium supplements can interfere with the metabolism
of a number of medications, including levothyroxine. The nurse should instruct the
client to avoid taking calcium within 4 hr of levothyroxine administration.
A nurse is conducting an admission history for a client who is to undergo a CT
scan with an IV contrast agent. The nurse should identify that which of the
following findings requires further assessment? - ANSWER: History of asthma
A client who has a history of asthma has a greater risk of reacting to the contrast
dye used during the procedure. Other conditions that can result in a reaction to
contrast media include allergies to foods, such as shellfish, eggs, milk, and
chocolate.
A nurse in an ICU is assessing a client who has a traumatic brain injury. Which of
the following findings should the nurse identify as a component of Cushing's triad?
- ANSWER: Bradycardia
A client who has increased intracranial pressure from a traumatic brain injury can
develop bradycardia, which is one component of Cushing's triad. The other
components of Cushing's triad are severe hypertension and a widened pulse
pressure.
A nurse is planning to irrigate and dress a clean, granulating wound for a client
who has a pressure injury. Which of the following actions should the nurse take? -
ANSWER: Use a 30-mL syringe
,Page 3 of 38
The nurse should use a 30-mL to 60-mL syringe with an 18- or 19- gauge catheter
to deliver the ideal pressure of 8 pounds per square inch (psi) when irrigating a
wound. To maintain healthy granulation tissue, the wound irrigation should be
delivered at between 4 and 15 psi.
A nurse in an emergency department is reviewing the provider's prescriptions for a
client who sustained a rattlesnake bite to the lower leg. Which of the following
prescriptions should the expect? - ANSWER: Administer an opioid analgesic to
the client.
The nurse should expect a prescription for an opioid analgesic to promote comfort
following a rattlesnake bite.
A nurse is reviewing the health record of a client who is scheduled for allergy skin
testing. The nurse should postpone the testing and report to the provider which of
the following findings? (Click on the "Exhibit" button for additional information
about the client). - ANSWER: Current medications
The nurse should review the client's medication record and identify medications,
including ACE inhibitors, beta blockers, theophylline, nifedipine, and
glucocorticoids, such as prednisone, that can alter the allergy skin test results.
These medications can diminish the client's reaction to the allergens. The nurse
should notify the provider and instruct the client to discontinue prednisone for 2
weeks before allergy skin testing.
A nurse is a caring for a client who is on bed rest and has a new prescription for
enoxaparin subcutaneous. Which of the following actions should the nurse take? -
ANSWER: Inject the medication into the anterolateral abdominal wall.
, Page 4 of 38
The nurse should inject the medication into the anterolateral or posterolateral
abdominal wall to enhance medication absorption and prevent hematoma
formation.
A nurse is caring for a client who has a stage III pressure injury. Which if the
following findings contribute to delayed wound healing? - ANSWER: Urine
output 25 mL/hr
Urinary output reflects fluid status. Inadequate urine output can indicate
dehydration, which can delay wound healing.
A nurse is caring for a client who has a new prescription for total parenteral
nutrition (TPN). The client is to receive 2,000 kcal per day. The TPN solution has
500kcal/L. The IV pump should be set at how many mL/hr? (Rounding to the
nearest whole number.) - ANSWER: 167 mL/hr
A nurse is teaching a client who has a family history of colorectal cancer. To help
mitigate this risk, which of the following dietary alterations should the nurse
recommend? - ANSWER: Add cabbage to the diet.
To help reduce the risk for colorectal cancer, the client should consume a diet that
is high in fiber, low in fat, and low in refined carbohydrates. Brassica vegetables
such as cabbage, cauliflower, and broccoli, are high in fiber.
A nurse is caring for a client who has a prescription for silver sulfadiazine cream to
be applied to her burn wounds. The nurse should evaluate the client for which of
the following laboratory findings? - ANSWER: Leukopenia
Transient leukopenia is an adverse effect of silver sulfadiazine.
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