ATI Capstone Adult Medical Surgical Assessment 2

ATI Capstone Adult Medical Surgical Assessment 2 Related

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What is the priority action for a patient experiencing chest pain from acute coronary syndrome?

  • A. Administer sublingual nitroglycerin
  • B. Administer aspirin
  • C. Obtain IV access
  • D. Check cardiac enzymes
Correct Answer: A

Rationale: The correct answer is to administer sublingual nitroglycerin. This medication helps to dilate the blood vessels, reduce the workload on the heart, and improve blood flow to the heart muscle, providing immediate relief for chest pain in acute coronary syndrome. Administering aspirin is also crucial in the early management of acute coronary syndrome to prevent further clot formation. However, in terms of immediate symptom relief, nitroglycerin takes precedence over aspirin. Obtaining IV access is important for administering medications and fluids but is not the priority over providing immediate relief for chest pain. Checking cardiac enzymes is essential for diagnosing acute coronary syndrome but is not the immediate priority when a patient is experiencing chest pain.

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What are the signs and symptoms of a hemorrhagic stroke?

  • A. Sudden severe headache, decreased level of consciousness, and seizures
  • B. Loss of consciousness and weakness
  • C. Temporary vision loss
  • D. Severe chest pain and shortness of breath
Correct Answer: A

Rationale: The correct answer is A. A hemorrhagic stroke often presents with a sudden severe headache, decreased level of consciousness, and seizures due to bleeding in the brain. Choice B, loss of consciousness and weakness, is more indicative of an ischemic stroke where a clot blocks blood flow to the brain. Choice C, temporary vision loss, is more commonly seen in conditions like transient ischemic attacks (TIAs) or retinal migraines. Choice D, severe chest pain and shortness of breath, are symptoms more associated with cardiac issues like a heart attack.

What are the expected changes on an ECG for a patient with hypokalemia?

  • A. Flattened T waves
  • B. Prominent U waves
  • C. ST elevation
  • D. Wide QRS complexes
Correct Answer: A

Rationale: Flattened T waves are an early sign of hypokalemia on an ECG. Hypokalemia primarily manifests as flattened T waves on an ECG. While prominent U waves can be seen in hypokalemia, they are not as specific as flattened T waves. ST elevation is more commonly associated with conditions like myocardial infarction rather than hypokalemia. Wide QRS complexes are typically not a feature of hypokalemia on an ECG.

What ECG changes are associated with hyperkalemia?

  • A. Flattened T waves
  • B. ST depression
  • C. Prominent U waves
  • D. Elevated ST segments
Correct Answer: B

Rationale: Hyperkalemia is known to cause ST depression on an ECG. Flattened T waves are more commonly seen in hypokalemia. Prominent U waves are associated with hypokalemia rather than hyperkalemia. Elevated ST segments are not typical findings in hyperkalemia.

A patient with GERD is receiving dietary teaching from a nurse. What should the nurse recommend?

  • A. Avoid mint and pepper
  • B. Increase fluid intake before meals
  • C. Eat three large meals per day
  • D. Avoid drinking water with meals
Correct Answer: A

Rationale: The correct recommendation for a patient with GERD is to avoid foods like mint and pepper, as these can help reduce gastric acid secretion and alleviate symptoms. Mint and pepper are known to relax the lower esophageal sphincter, leading to increased reflux. Increasing fluid intake before meals (choice B) may worsen GERD symptoms by distending the stomach. Eating three large meals per day (choice C) can also aggravate GERD because large meals can lead to increased gastric pressure and reflux. Avoiding drinking water with meals (choice D) is generally recommended for GERD; however, the most crucial advice in this case is to avoid mint and pepper for better symptom management.

What is a characteristic sign of hypokalemia on an ECG?

  • A. Flattened T waves
  • B. ST elevation
  • C. Prominent U waves
  • D. Widened QRS complex
Correct Answer: A

Rationale: Flattened T waves are a characteristic sign of hypokalemia on an ECG. When potassium levels are low, it can lead to changes in the ECG, such as T wave flattening. This alteration is important to recognize as it indicates potential electrolyte imbalances. ST elevation (Choice B) is not typically associated with hypokalemia but can be seen in conditions like myocardial infarction. Prominent U waves (Choice C) are associated with hypokalemia, but flattened T waves are more specific. Widened QRS complex (Choice D) is not a typical ECG finding in hypokalemia but can be seen in conditions like hyperkalemia.

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