ATI Adult Medical Surgical

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An elderly female client comes to the clinic for a regular check-up. The client tells the nurse that she has increased her daily doses of acetaminophen (Tylenol) for the past month to control joint pain. Based on this client's comment, what previous lab values should the nurse compare with today's lab report?

  • A. Look at last quarter's hemoglobin and hematocrit to assess for dehydration.
  • B. Look for an increase in today's LDH compared to the previous one to assess for possible liver damage.
  • C. Expect to find an increase in today's APTT compared to last quarter's due to bleeding.
  • D. Determine if there is a decrease in serum potassium due to renal compromise.
Correct Answer: B

Rationale: The correct answer is B. The nurse should look for an increase in today's LDH compared to the previous one to assess for possible liver damage. Acetaminophen overdose can lead to liver toxicity, which can be indicated by elevated LDH levels. LDH is an enzyme released during liver damage. Checking for LDH levels can help assess the impact of increased acetaminophen doses on the liver.

Choices A, C, and D are incorrect:
A: Looking at hemoglobin and hematocrit is not directly related to acetaminophen use for joint pain. It does not provide information about liver damage.
C: APTT measures blood clotting time and is not directly affected by acetaminophen use for joint pain. It does not provide information about liver damage.
D: Serum potassium levels are not typically affected by acetaminophen use for joint pain. It does not provide information about liver damage.

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The nurse is administering sevelamer (RenaGel) during lunch to a client with end-stage renal disease (ESRD). The client asks the nurse to bring the medication later. The nurse should describe which action of RenaGel as an explanation for taking it with meals?

  • A. Prevents indigestion associated with the ingestion of spicy foods.
  • B. Binds with phosphorus in foods and prevents absorption.
  • C. Promotes stomach emptying and prevents gastric reflux.
  • D. Buffers hydrochloric acid and prevents gastric erosion.
Correct Answer: B

Rationale: The correct answer is B. Sevelamer (RenaGel) is a phosphate binder used in ESRD to bind with phosphorus in foods, preventing its absorption in the gastrointestinal tract. This is important as ESRD patients often have high levels of phosphorus in their blood, which can lead to complications like cardiovascular disease. Taking RenaGel with meals ensures that it binds with phosphorus in the food, reducing its absorption.

Choice A is incorrect as RenaGel does not prevent indigestion associated with spicy foods. Choice C is incorrect as RenaGel does not promote stomach emptying or prevent gastric reflux. Choice D is incorrect as RenaGel does not buffer hydrochloric acid or prevent gastric erosion.

A patient with hypertension is prescribed lisinopril. What side effect should the nurse monitor for?

  • A. Hyperkalemia
  • B. Hypoglycemia
  • C. Bradycardia
  • D. Constipation
Correct Answer: A

Rationale: The correct answer is A: Hyperkalemia. Lisinopril is an ACE inhibitor that can cause potassium retention, leading to hyperkalemia. Monitoring potassium levels is crucial to prevent serious complications like cardiac arrhythmias. Hypoglycemia (B) is not a common side effect of lisinopril. Bradycardia (C) and constipation (D) are also not typically associated with lisinopril use. Hyperkalemia is the most critical side effect to monitor in this case.

A client with a history of peptic ulcer disease is admitted with severe abdominal pain. Which assessment finding should the nurse report to the healthcare provider immediately?

  • A. Bowel sounds active in all quadrants.
  • B. Blood pressure of 110/70 mm Hg.
  • C. Rigid, board-like abdomen.
  • D. Heart rate of 90 beats per minute.
Correct Answer: C

Rationale: The correct answer is C: Rigid, board-like abdomen. This finding suggests peritonitis, a serious complication of peptic ulcer disease, requiring immediate medical intervention. A: Active bowel sounds are expected. B: Blood pressure is within normal range. D: Heart rate is slightly elevated but not a critical finding. In summary, a rigid abdomen indicates peritonitis and requires urgent attention compared to the other choices.

What should be monitored to evaluate the effectiveness of enoxaparin in a patient with deep vein thrombosis (DVT)?

  • A. Prothrombin time (PT)
  • B. Partial thromboplastin time (PTT)
  • C. International normalized ratio (INR)
  • D. Platelet count
Correct Answer: C

Rationale: Rationale:
1. Enoxaparin is a low molecular weight heparin that primarily affects the intrinsic pathway of coagulation.
2. INR is used to monitor the effectiveness of anticoagulants affecting the intrinsic pathway.
3. Monitoring INR helps ensure the patient is within the therapeutic range to prevent clotting without excessive bleeding.
4. PT and PTT primarily evaluate the extrinsic and intrinsic pathways, respectively, not specific to enoxaparin.
5. Platelet count is not directly related to monitoring the effectiveness of enoxaparin in treating DVT.

A patient with chronic pain is prescribed a fentanyl patch. What is the most important instruction for the nurse to provide?

  • A. Apply the patch to a different site each time.
  • B. Change the patch every 72 hours.
  • C. Avoid using additional heating pads over the patch.
  • D. Remove the patch before showering.
Correct Answer: B

Rationale: The correct answer is B: Change the patch every 72 hours. Fentanyl patches are typically designed to be worn for 72 hours before being replaced to maintain consistent pain relief. Changing the patch on time helps prevent withdrawal symptoms and ensures the effectiveness of the medication.

A: Applying the patch to a different site each time is important to prevent skin irritation but is not the most crucial instruction.
C: Avoiding heating pads over the patch is important to prevent overheating and excessive absorption of the medication, but changing the patch timely is more critical.
D: Removing the patch before showering is not necessary as fentanyl patches are designed to be water-resistant.

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