MED-SURG 200

ATI MED-SURG 200

Total Questions : 58

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Question 1: View

While obtaining a nursing history from a client with inflammatory bowel disease, the nurse recognizes that the client most likely has ulcerative colitis rather than Crohn's disease when the client reports experiencing:

Explanation

D. Bloody diarrhea is a hallmark symptom of ulcerative colitis, particularly during disease flares. It typically presents as frequent and urgent bowel movements containing blood, mucus, and pus. Crohn's disease, on the other hand, may present with bloody diarrhea but usually involves less frequent bowel movements.
A. Both ulcerative colitis and Crohn's disease can manifest at various ages, including during adolescence and early adulthood.
B. Abdominal pain and cramping are common symptoms of both ulcerative colitis and Crohn's disease.
C. Weight loss can occur in both ulcerative colitis and Crohn's disease due to factors such as decreased appetite, malabsorption, and inflammation of the gastrointestinal tract.


Question 2: View

The nurse is teaching the client about successful strategies for weight loss. Which would the nurse include? (SELECT ALL THAT APPLY)

Explanation

A. Daily weighing can help individuals monitor their progress and stay accountable for their weight loss goals. However, it's essential to emphasize that weight can fluctuate due to various factors such as hydration, digestion, and muscle mass changes, so the focus should be on overall trends rather than daily fluctuations.
B. Joining a support group can provide individuals with encouragement, motivation, and accountability during their weight loss journey. It allows them to connect with others who are facing similar challenges and share strategies for success.
D. Keeping a food diary or journal can be a valuable tool for promoting awareness of eating habits, tracking calorie intake, and identifying patterns or triggers for overeating. It helps individuals make informed choices about their diet and can contribute to successful weight loss by promoting accountability and mindfulness.
C. Use large, yellow plates is not typically included in successful weight loss strategies. Plate size and color may have minimal impact on food intake compared to factors such as portion control, food choices, and mindful eating practices.
E. Eating quickly and leaving the table can lead to overeating because it doesn't allow time for the body to register fullness signals.


Question 3: View

The nurse assesses a client admitted four hours ago with a diagnosis of diverticulitis. Which clinical manifestation must be reported immediately to the physician?

Explanation

B. Bowel sounds are typically present and indicate normal gastrointestinal motility. A change from normoactive (normal) to absent bowel sounds can indicate bowel obstruction, perforation, or peritonitis, which are serious complications of diverticulitis. This change warrants immediate reporting to the physician as it may indicate a worsening condition requiring urgent intervention.
A. A temperature of 101.2°F (38.4°C) is slightly elevated and may indicate the presence of infection, which is concerning in the context of diverticulitis. Fever is a common symptom of diverticulitis, but an elevated temperature may also suggest worsening infection or the development of complications such as abscess formation or perforation.
C. Left lower quadrant discomfort is a common symptom of diverticulitis due to inflammation in the sigmoid colon, where diverticula are most prevalent. While discomfort is expected in diverticulitis, the severity and persistence of pain should be assessed.
D. An elevated white blood cell (WBC) count is indicative of inflammation or infection and is commonly seen in diverticulitis. However, the significance of the elevation depends on the degree of increase and the presence of other clinical findings.


Question 4: View

The client has a possible diagnosis of appendicitis. On physical examination, the nurse should assess for tenderness on palpation at McBurney's point, located at which pictured site?

Explanation

McBurney's point is located approximately one-third of the distance from the anterior superior iliac spine (ASIS) to the umbilicus (navel), on the right side of the abdomen.


Question 5: View

Trimethoprim and sulfamethoxazole BID for 7 days is prescribed for a client who has a UTI caused by E.coli. The nurse instructs the client to:

Explanation

B. It is essential to complete the full course of antibiotics as prescribed by the healthcare provider, even if symptoms improve before the course is finished. This ensures that all bacteria causing the infection are eradicated, reducing the risk of recurrence and development of antibiotic resistance.
A. Antibiotics should be taken exactly as prescribed and for the full duration of the treatment course. Incomplete or inconsistent use of antibiotics can lead to incomplete eradication of the infection, development of antibiotic resistance, and recurrence of the infection.
C. While cranberry juice is often recommended for urinary tract health due to its ability to prevent bacterial adherence to the bladder wall, it is not a substitute for antibiotics in treating urinary tract infections.
D. Typically, urine cultures are reserved for cases where the diagnosis is uncertain, or the infection is recurrent or complicated. In uncomplicated UTIs, empirical antibiotic treatment based on symptoms and clinical presentation is usually sufficient.


Question 6: View

The client has lived with ulcerative colitis for close to 15 years and has learned to manage it very well. At this point in time, the nurse's discussion with the client about this disease should have a primary focus on which question?

Explanation

C. Medication adherence is vital for controlling inflammation and preventing flare-ups in ulcerative colitis. Therefore, ensuring that the client is taking their medications as prescribed is a primary focus of disease management, regardless of how well they have learned to manage the condition.
A. Stress can exacerbate symptoms of ulcerative colitis and may contribute to flare-ups. Therefore, understanding how the client manages stress is important. However, given that the client has lived with ulcerative colitis for close to 15 years and has learned to manage it well, this question may be less of a primary focus compared to other aspects of disease management.
B. Regular monitoring through colonoscopy is essential for detecting any changes or complications associated with ulcerative colitis, such as inflammation, dysplasia, or colon cancer.
D. While rest and adequate sleep are important for overall health and well-being, they may not be as directly related to ulcerative colitis management as medication adherence, monitoring, and stress management.


Question 7: View

The nurse is assessing a client who has a large bowel obstruction. Which late clinical finding would the nurse expect?

Explanation

A. Loops of large bowel become visibly outlined through the abdominal wall is a typical late clinical finding of a large bowel obstruction. In fact, visible loops of bowel through the abdominal wall may be observed in cases of a severe bowel obstruction, but it is not typically considered a late finding.

B. Intense thirst, parched tongue, and dry mucous membranes suggest dehydration, which can occur as a result of vomiting, decreased fluid intake, or fluid loss due to the obstruction. However, dehydration may occur earlier in the course of a bowel obstruction and may not be considered a late finding.
C. Vomiting in large bowel obstruction is commonly of fecal contents.
D. High-pitched, frequent bowel sounds is not a typical late clinical finding of a large bowel obstruction. Instead, bowel sounds are usually diminished or absent in cases of bowel obstruction due to decreased peristalsis beyond the site of obstruction.


Question 8: View

The nurse is assessing a client after bariatric surgery. The client complains of chest pain and shortness of breath. What is the priority nursing Intervention at this time?

Explanation

A. Sit the client up and provide supplemental oxygen is the correct priority intervention. Chest pain and shortness of breath can be indicative of pulmonary embolism or other respiratory complications, which require immediate attention. Sitting the client up helps improve respiratory mechanics, and providing supplemental oxygen can support oxygenation while further assessments are conducted.
B. While contacting the physician and obtaining an arterial blood gas may be necessary to assess respiratory status and oxygenation, it is not the immediate priority. The client's symptoms require immediate intervention to ensure adequate oxygenation and prevent further deterioration.
C. Chest pain and shortness of breath are not typically expected findings after bariatric surgery and could indicate serious complications. It is essential not to dismiss the client's symptoms but to take them seriously and initiate appropriate interventions.
D. While the use of an incentive spirometer is important for preventing respiratory complications after surgery, it is not the priority intervention in this situation. The client's current symptoms require immediate attention to address potential respiratory distress or other serious complications.


Question 9: View

A client with Type 2 diabetes is brought into the emergency room in an unresponsive state. A diagnosis of hyperglycemic hyperosmolar nonketotic coma (HHNK) is made. The nurse prepares for the administration of which initial therapy?

Explanation

B. Large amounts of IV saline solution: This is the correct initial therapy. HHNK is characterized by severe dehydration due to osmotic diuresis resulting from hyperglycemia. Therefore, the administration of large amounts of IV saline solution is essential to correct dehydration, restore intravascular volume, and improve tissue perfusion.
A. Glucagon is typically administered to treat severe hypoglycemia, not hyperglycemia.
C. Short-acting or regular insulin is administered initially to lower blood glucose levels rapidly. Long-acting insulin formulations may be used later to maintain glycemic control once the acute phase is managed.
D. Oxygen therapy may be indicated if the client is hypoxic, but it is not the initial therapy for HHNK. The priority in HHNK is to correct dehydration and hyperglycemia through fluid resuscitation and insulin therapy, respectively.


Question 10: View

The nurse is caring for a client receiving total parenteral nutrition (TPN). The nurse understands that the best explanation for utilizing TPN is to:

Explanation

C. TPN does provide all of the client's nutritional needs, including carbohydrates, proteins, fats, vitamins, minerals, and electrolytes, in a hypertonic solution. The hypertonicity of the solution is necessary to prevent fluid overload and ensure compatibility with the vasculature. The hypertonic solution allows for higher nutrient concentrations to be delivered without exceeding vascular capacity.
A. TPN is indicated for clients who are unable to tolerate enteral nutrition (feeding through the gastrointestinal tract) or have impaired absorption, digestion, or utilization of nutrients despite having active GI function.
B. TPN may be used temporarily after a surgical procedure if the client is unable to tolerate oral or enteral feeding or if enteral nutrition is contraindicated due to the surgical site or condition. However, TPN is not limited to short-term use after surgery and may be required for an extended period in clients with chronic conditions or prolonged inability to tolerate enteral nutrition.
D. TPN may be used in some cases after a laparotomy for a bowel obstruction, particularly if enteral nutrition is contraindicated or if the client is unable to tolerate oral intake. However, TPN is not primarily used to prevent complications after surgery but rather to provide nutritional support when enteral feeding is not feasible or sufficient.


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