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ATI Capstone Adult Medical Surgical Assessment 2.pdf, Exams of Nursing

Chamberlain College of NursingNursing

ATI Capstone Adult Medical Surgical Assessment 2.pdf

Typology: Exams

2023/2024

Available from 07/17/2024

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ATI Capstone Adult Medical Surgical Assessment 2
A 45-year-old client is taking methylprednisolone. What pharmacologic action should
the nurse expect with this therapy?
1) Suppression of beta2 receptors
2)Suppression of airway mucus production
3) Fortification of bones
4) Suppression of candidiasis - ans2) Suppression of airway mucus production
Corticosteroids, such as methylprenisolone will suppress airway mucus production
A 52-year-old client with a history of angina has been prescribed transdermal
nitroglycerin. Which of the following adverse effects is not seen with this therapy?
1) Tolerance
2) Orthostatic hypotension
3) Headache
4) Productive cough - ans4) Productive cough
Nitroglycerin therapy does not directly have an effect lung function. Physiologically,
vasodilation should effect capillary perfusion and decrease lung secretions
A 55-year-old client has levothyroxine ordered. Which of the below past medical history
concerns may contraindicate with her medication management of hypothyroidism?
1) Scleroderma
2) Osteoporosis
3) Asthma
4) Peripheral Vascular Disease - ans2) Osteoprosis
There is an increased risk for fracture, especially in older adults
A client has been prescribed isosorbide monoitrate. Which of the following should the
nurse include in this client's education related to this medication?
1) This medication is prescribed for long-term therapy prophylaxis against anginal
attacks
2) You can crush this medication if needed
3) Take the medication in the evening after dinner
4) Take an additional tablet if you experience chest pain - ans1) This medication is
prescribed for long-term prophylaxis against anginal attacks
Isosorbide mononitrate is used for long-term prophylaxis against anginal attacks
A client has been prescribed lisinopril. Which of the following medication interactions
should the nurse instruct this client about?
1) Potassium supplements
2) Ciprofloxacin
3) Escitalopram
4) Magnesium supplements - ans1) Potassium supplements
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A 45-year-old client is taking methylprednisolone. What pharmacologic action should the nurse expect with this therapy?

  1. Suppression of beta2 receptors 2)Suppression of airway mucus production
  2. Fortification of bones
  3. Suppression of candidiasis - ans2) Suppression of airway mucus production Corticosteroids, such as methylprenisolone will suppress airway mucus production A 52-year-old client with a history of angina has been prescribed transdermal nitroglycerin. Which of the following adverse effects is not seen with this therapy?
  4. Tolerance
  5. Orthostatic hypotension
  6. Headache
  7. Productive cough - ans4) Productive cough Nitroglycerin therapy does not directly have an effect lung function. Physiologically, vasodilation should effect capillary perfusion and decrease lung secretions A 55-year-old client has levothyroxine ordered. Which of the below past medical history concerns may contraindicate with her medication management of hypothyroidism?
  8. Scleroderma
  9. Osteoporosis
  10. Asthma
  11. Peripheral Vascular Disease - ans2) Osteoprosis There is an increased risk for fracture, especially in older adults A client has been prescribed isosorbide monoitrate. Which of the following should the nurse include in this client's education related to this medication?
  12. This medication is prescribed for long-term therapy prophylaxis against anginal attacks
  13. You can crush this medication if needed
  14. Take the medication in the evening after dinner
  15. Take an additional tablet if you experience chest pain - ans1) This medication is prescribed for long-term prophylaxis against anginal attacks Isosorbide mononitrate is used for long-term prophylaxis against anginal attacks A client has been prescribed lisinopril. Which of the following medication interactions should the nurse instruct this client about?
  16. Potassium supplements
  17. Ciprofloxacin
  18. Escitalopram
  19. Magnesium supplements - ans1) Potassium supplements

Potassium supplements and potassium-sparing diuretics increase the risk of hyperkalemia in clients taking ACE inhibitors such as lisinopril. Clients should only take potassium supplements if prescribed by the provider. Clients should also avoid salt substitutes that contain potassium A client has been prescribed metoclopramide. Which of the following should the nurse include in client education regarding this medication?

  1. Notify your provider if you experience restlessness or spasms of the face or neck
  2. This medication can cause insomnia
  3. Decrease your fluid intake while taking this medication
  4. This medication can cause urinary frequency - ans1) Notify your provider if your experience restlessness or spams of the face or neck An adverse effect of metoclopramide is extrapyramidal symptoms. The client should stop the medication and notify the provider if these occur A client has been prescribed vasopressin for the treatment of diabetes insipidus. What is the expected pharmacologic actions of this medication?
  5. To stimulate the pancreas to secrete insulin
  6. To slow the absorption of glucose in the intestine
  7. To increase reabsorption of water in the renal tubules
  8. To increase blood pressure - ans3) To increase reabsorption of water in the renal tubules The expected pharmacologic action is to promote reabsorption of water within the kidney A client is prescribed propanolol. Which of the following client history findings would require the nurse to clarify this medication prescription?
  9. Asthma
  10. Hypertension
  11. Tachydysrhythmias
  12. Urolithiasis - ans1) Asthma Clients with asthma should avoid Beta2 Blockade agents such as propanolol. Brochoconstriction can occur. Clients with asthma should be administered a beta selective agent A nurse has just administered a wrong medication to a client. Which of the following actions should the nurse take next?
  13. No action is needed
  14. Report error to the provider
  15. Complete an institutional incident report
  1. Take the medication on an empty stomach to maximize absorption
  2. Notify your provider if your stool becomes dark green
  3. Decrease dietary fiber intake while taking this medication
  4. Take prescribed antacids at the same time as this medication - ans1) Take this medication on an empty stomach to maximize absorption The nurse should instruct the clients to take iron on an empty stomach, such as 1 hr before meals to maximize absorption. Stomach acid increases absorption. If GI adverse effects occur, the client can take with food to increase adherence to therapy even though absorption is also decreased A nurse is caring for a client prescribed HMG CoA reductase inhibitor, atorvastatin. Which of the following should be monitored while this medication is prescribed?
  5. Liver function tests
  6. Renal function tests
  7. Visual acuity screening
  8. Hearing screenings - ans1) Liver function tests Statins (HMG CoA reductase inhibitors) like atorvastatin can cause hepatotoxicity. Prior to initiating therapy the client's baseline liver function should be determined then liver function tests should be checked after 12 weeks of therapy and then every 6 months. The nurse should advise the client to observe for symptoms of liver dysfunction (anorexia, vomiting, nausea, jaundice) and to notify the provider if these occur A nurse is caring for a client prescribed hydromorphone for severe pain. The client's respiratory rate has decreased from 16 breaths per minute to 6. Which of the following medication should the nurse prepare to administer?
  9. Flumazenil
  10. Naloxone
  11. Activated charcoal
  12. Aluminum hydroxide - ans2) Naloxone The client is experiencing respiratory depression likely related to over administration of hydromorphone (Dilaudid). Naloxone (Narcan) and nalmefene (Revex) are opioid antagonsists used to reverse an overdose of opioids. A nurse is caring for a client prescribed montelukast. Which of the following should the nurse include in teaching related to this medication?
  13. Advise client to take the medication once daily at bedtime
  14. This medication is for acute management of asthma
  15. Avoid dairy products while taking this medication
  16. If the client forgets to take the medication for a few days he can double up on doses to catch up - ans1) Advise client to take the medication once daily at bedtime Clients should take montelukast once daily at bedtime

A nurse is caring for a client receiving a dopamine infusion via a peripheral IV. Which of the following actions should the nurse take if the IV site appears infiltrated?

  1. Slow the infusion and continue to monitor the site
  2. Stop the infusion
  3. Apply a warm compress to the site
  4. Apply a cold compress to the site - ans2) Stop the infusion If infiltration is suspected, the infusion should be stopped. Necrosis can occur from extravasation of high doses of dopamine. Extravasation can be treated with local injection of an alpha-adrenergic blocking agent, such as phentolamine A nurse is caring for a client receiving patient-controlled analgesia (PCA). Which of the following interventions should the nurse take while caring for this client?
  5. Advise the client to use the pump sparingly to prevent addiction
  6. Encourage the client to use the PCA before dressing changes
  7. Encourage the client's family to administer PCA while client is sleeping
  8. Increase client's 4-hr limit as needed - ans2) Encourage the client to use the PCA before dressing changes The nurse should encourage the client to use the PCA prophylactically prior to activities that are likely to augment pain levels A nurse is caring for a client who has diabetes and a new prescription for 14 units of regular insulin and 28 units of NPH insulin subcutaneously at breakfast daily. What is the total number of units of insulin that the nurse should prepare in the insulin syringe?
  9. 14 units
  10. 28 units
  11. 32 units
  12. 42 units - ans4) 42 units Each order of for units of insulin is combined in the same syringe. The nurse should withdrawal the regular insulin into the syringe first A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin?
  13. Hemoglobin (Hgb)
  14. Prothrombin tie (PT)
  15. Bleeding time
  16. Activated partial thromboplastin time (aPTT) - ans2) Prothrombin time (PT) This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation

A nurse is preparing to administer morphine sulfate 2 mg IV bolus. Available is morphine sulfate 10 mg/mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.) - ans0.2 mL A nurse is providing care to a client with staphylococcus epidermidis, who is prescribed vancomycin. Identify the adverse effect associate with the antibiotic therapy?

  1. Hepatotoxicity
  2. Constipation
  3. Infusion reaction
  4. Immunosuppression - ans3) Infusion reaction Red Man Syndrome or an infusion reaction that results in rashes, flushing, tachycardia and hypotension can occur as an adverse reaction. For this reason, vancomycin should be administered over a 60 minute period A nurse is reviewing the medication class benzodiazepines. The nurse would use cautions when administering benzodiazepines to which of the below clients?
  5. A client with glaucoma
  6. A client with renal failure
  7. A client with hypertension
  8. A client with insomnia - ans1) A client with glaucoma Benzodiazepines can increase intraocular pressure due to the pupil-dilating effects of the medication Before administering blood products, which action should be taken?
  9. Assess the client's temperature
  10. Document client response
  11. Prime IV tubing with 0.45% sodium chloride
  12. Administer epinephrine - ans1) Assess the client's temperature Assess the client's vital signs, obtain consent for the procedure and ensure compatibility. Prime the IV tubing with 0.9% sodium chloride. The nurse would not document client response or administer epinephrine prior to starting the transfusion Disulfiram is taken by a client daily for abstinence maintenance. What is an adverse effect of this therapy?
  13. Hepatoxicity
  14. Wernicke's aphasia
  15. Suicidal ideations
  16. Diarrhea - ans1) Hepatoxicity Hepatoxicity is an adverse effect of disulfiram

Which of the following are contraindications to salicylate acid therapy? Select all that apply *Third trimester pregnancy *Thrombocytopenia *Coronary artery disease *Adolescents with chickenpox Deep vein thrombosis - ansThird trimester pregnancy *Throbocytopenia *Adolescents with chickenpox Salicylate Acid Therapy Contraindications: Salicylate acid is a category D agent and should not be administered to pregnant clients. Salicylate acid is contraindicated in clients with bleeding disorders and thrombocytopenia. Salicylate acid should not be given to children or adolescents with fever or recent chickenpox due to the risk of Reye's syndrome. The therapy is used for the following types of clients: Salicylate acid inhibits platelet aggregation and is often used in the treatment and prevention of thrombosis. Salicylate acid is commonly prescribed to clients with coronary artery disease to prevent thrombus formation A nurse enters a client's room and finds the client on the floor experiencing a seizure. Which of the following actions should the nurse take? - ANSPosition the client on their side. The nurse should position the client on their side. This assists the client's airway to remain open and can prevent aspiration if the client has emesis or secretions in their mouth. A nurse is assessing a client who has enlarged lymph nodes. In which of the following locations should the nurse palpate to locate the postauricular nodes? - ANSOver the mastoid The nurse should palpate over the mastoid or behind the ear to assess the postauricular nodes. The detection of an enlarged or tender lymph node can indicate the presence of an infection or a malignancy and should be reported to the provider. A nurse is assessing a client who has multiple sclerosis. Which of the following assessments is the nurse's priority? - ANSAbility to swallow The greatest risk to the client is aspiration due to dysphagia. Therefore, the nurse's priority assessment is the client's ability to swallow.

A nurse is planning to discharge a client who had a stroke 1 week ago to home. The nurse should collaborate with which of the following members of the interprofessional team to assist the client with the preparation of nutritious meals? - ANSRegistered dietitian The nurse should collaborate with the registered dietitian for assistance with the preparation of nutritious meals. The registered dietitian has the specific dietary knowledge to assist both the client and those who may be assisting the client. A nurse is preparing to administer medications to a client. Which of the following information should the nurse use to verify the client's identity? - ANSHome telephone number The nurse should recognize the client's home telephone number is an acceptable identifier to use when identifying the client prior to medication administration. Other acceptable client identifiers can be the client's medical identification number, the name on the client's wristband, or a photograph of the client. A nurse is reviewing a new prescription from a provider that reads: regular insulin 12 units before meals. Which of the following parts of the prescription should the nurse clarify with the provider? - ANSRoute of administration The nurse should identify the route of administration for the medication is missing from the prescription. All prescriptions should include the client's name, the date and time of the prescription, the name of the medication, the dose, and the frequency of administration along with the provider's name and the name of the person who is transcribing the prescription. A nurse is teaching a client who has COPD about how to use an incentive spirometer. Which of the following instructions should the nurse include? - ANS"Cough after the incentive spirometer procedure." The nurse should encourage the client to cough following the incentive spirometer procedure. After breathing deeply, secretions can become loose and coughing can help to remove them. A nurse is teaching a client who is scheduled for an intravenous pyelogram. The nurse should identify that which of the following client statements indicates an understanding of the procedure? - ANS"Contrast dye will be used for this test." The nurse should ensure the client understands that a contrast dye is injected through a vein to visualize the passage of urine from the renal pelvis to the bladder. This study is used to diagnose hematuria or obstruction of the urinary tract and can identify the presence of renal calculi or tumors.

A nurse manager is teaching about the rights of delegation to assistive personnel (AP) and practical nurses (PN). Which of the following examples should the nurse manager include in the teaching? - ANSDelegating a PN to insert an indwelling urinary catheter The insertion of an indwelling urinary catheter is a nursing responsibility. The RN must be the one to assess the client's need for catheterization and can then delegate the responsibility of insertion to a PN. Due to the knowledge of anatomy and sterile technique, this task does not fall within the range of function for an AP.