ATI Custom: AH2- FA25- Exam 3
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Free ATI Custom: AH2- FA25- Exam 3 Questions
A nurse is caring for a client with breast cancer experiencing hypercalcemia. Which of the following medications is commonly used for the treatment of hypercalcemia?
- A. Zoledronic acid
- B. Omeprazole
- C. Furosemide
- D. Metformin
Explanation
Zoledronic acid is a bisphosphonate medication commonly used to treat hypercalcemia of malignancy. It works by inhibiting osteoclast-mediated bone resorption, thereby reducing calcium release from bones into the bloodstream. This medication is especially beneficial for clients with cancers that metastasize to bone, such as breast cancer. It is administered intravenously and helps lower serum calcium levels while providing bone protection against further metastasis.
A nurse is reviewing the laboratory data of a client who has acute pancreatitis. The nurse should expect to find an elevation of which of the following values?
- A. Magnesium
- B. Calcium
- C. Amylase
- D. RBC count
Explanation
In acute pancreatitis, pancreatic enzymes such as amylase and lipase leak into the bloodstream due to inflammation and autodigestion of the pancreas. Elevated serum amylase is one of the hallmark diagnostic findings, typically rising within hours of symptom onset and remaining elevated for several days. High amylase levels reflect pancreatic injury and help confirm the diagnosis alongside elevated lipase, which is more specific to the pancreas.
A client is recovering from a stroke and is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which should the nurse expect to be prescribed for this client? (Select All that Apply.)
- A. Fluid restriction
- B. Hypertonic saline
- C. Carbamazepine
- D. Loop diuretic
- E. Conivaptan
Explanation
Explanation of Correct Answers
A. Fluid restriction
Fluid restriction is the cornerstone of SIADH management. Since the condition involves excessive release of antidiuretic hormone leading to water retention and dilutional hyponatremia, restricting fluid intake helps correct serum sodium levels and prevent further fluid overload and cerebral edema.
B. Hypertonic saline
For severe hyponatremia or neurological symptoms such as seizures, 3% hypertonic saline may be prescribed to increase serum sodium levels safely. It must be administered cautiously and under close monitoring to avoid rapid correction, which can lead to central pontine myelinolysis.
D. Loop diuretic
Loop diuretics such as furosemide may be used to promote water excretion and reduce fluid retention. They are particularly effective when combined with hypertonic saline to help increase serum sodium levels while controlling total body fluid.
E. Conivaptan
Conivaptan is a vasopressin receptor antagonist (vaptan) that blocks the effect of ADH on renal collecting ducts, promoting free water excretion without electrolyte loss. It helps correct hyponatremia in SIADH by addressing the underlying hormone imbalance.
A nurse is caring for a client who has benign prostatic hyperplasia (BPH). Which of the following medications should the nurse plan to administer?
- A. Finasteride
- B. Fluoxymesterone
- C. Methyltestosterone
- D. Danazol
Explanation
Finasteride is a 5-alpha-reductase inhibitor that blocks the conversion of testosterone to dihydrotestosterone (DHT), the hormone responsible for prostate enlargement. This action reduces prostate size over time, improving urinary flow and relieving symptoms of BPH such as urinary retention and frequency. Finasteride is commonly prescribed for long-term management, and clients should be taught that noticeable improvement may take several months of consistent use.
A nurse cares for a client receiving chemotherapy. Which of the following are appropriate actions when handling bodily fluids from a client receiving chemotherapy? (Select All that Apply.)
- A. Respiratory protection should be worn if there is risk for inhalation exposure when cleaning bodily fluid spills
- B. Soiled linens should be kept separated and not combined with other client’s linens
- C. Pour fluids down the sink with running water
- D. Wear gloves and other appropriate personal protective equipment (PPE) when handling the fluids
- E. Flush the fluids down the toilet
- F. Dispose of the fluids in regular trash bins
Explanation
Explanation of Correct Answers
A. Respiratory protection should be worn if there is risk for inhalation exposure when cleaning bodily fluid spills
Chemotherapy drugs and their metabolites can become aerosolized during spill cleanup. Using respiratory protection, such as a mask or respirator, prevents inhalation exposure to these hazardous substances. This is part of safe handling precautions to minimize occupational risk.
B. Soiled linens should be kept separated and not combined with other client’s linens
Linens contaminated with chemotherapy agents or body fluids should be isolated in clearly labeled, leak-proof bags. This prevents cross-contamination and protects laundry staff and other patients from accidental exposure.
D. Wear gloves and other appropriate personal protective equipment (PPE) when handling the fluids
Gloves, gowns, and face shields should always be used when handling chemotherapy or contaminated body fluids. Chemotherapy can be excreted through urine, feces, vomit, and sweat for up to 48 hours after administration, requiring strict PPE use for safe handling.
E. Flush the fluids down the toilet
Bodily fluids from clients receiving chemotherapy may be safely flushed down the toilet if proper precautions are followed. The nurse should ensure the lid is closed before flushing to prevent splashing or aerosolization, and double flushing is recommended to ensure complete disposal.
A nurse is caring for a client in a clinic who has foul-smelling urine, a low-grade fever of 37.7° C (100° F), and pain with urination. The client developed acute kidney injury with a creatinine of 1.6. Which of the following should the nurse expect the health care provider to order? (Select All that Apply.)
- A. Broad-spectrum antibiotic
- B. 0.9% sodium chloride infusion at 100 mL/hr
- C. WBC count
- D. A clean-catch urinalysis and urine culture
- E. Foley catheter placement
- F. Liver function tests
Explanation
Explanation of Correct Answers
A. Broad-spectrum antibiotic
The client’s foul-smelling urine, dysuria, and fever indicate a urinary tract infection (UTI) that could have progressed to pyelonephritis. Prompt administration of a broad-spectrum antibiotic is essential to treat the infection and prevent further kidney injury or sepsis while awaiting culture results.
B. 0.9% sodium chloride infusion at 100 mL/hr
Fluid replacement with normal saline helps maintain renal perfusion, promote urine output, and prevent worsening of acute kidney injury (AKI) due to dehydration or infection-related volume loss.
C. WBC count
A complete blood count (CBC) with WBC measurement helps evaluate the presence and severity of infection or inflammation. Leukocytosis supports the diagnosis of systemic infection.
D. A clean-catch urinalysis and urine culture
These tests confirm infection by identifying the presence of bacteria, leukocytes, and nitrites, and specify the causative organism and antibiotic sensitivity for targeted therapy.
Based on the client’s clinical presentation and assessment findings, which findings are consistent with diabetic ketoacidosis (DKA) and which are consistent with hyperosmolar hyperglycemic state (HHS)?
- A. Polyuria/polydipsia – DKA and HHS
- B. Kussmaul respirations – DKA
- C. Altered mental status – DKA and HHS
- D. Serum bicarbonate less than 15 mEq/L – DKA
- E. Physiological stressor as precipitating factor – DKA and HHS
Explanation
Explanation of Correct Answers
Polyuria/polydipsia – DKA and HHS:
Both DKA and HHS result from severe hyperglycemia, which causes osmotic diuresis. The kidneys attempt to excrete excess glucose, leading to large volumes of urine output (polyuria). This loss of fluid triggers excessive thirst (polydipsia) as the body tries to compensate for dehydration.
Kussmaul respirations – DKA:
Deep, rapid breathing (Kussmaul respirations) occurs in DKA as a compensatory mechanism for metabolic acidosis caused by ketone buildup. This pattern helps blow off carbon dioxide to restore acid-base balance. Kussmaul respirations are a hallmark finding of DKA and are not seen in HHS, as acidosis is minimal or absent in HHS.
Altered mental status – DKA and HHS:
Both conditions can cause confusion, lethargy, or decreased consciousness due to dehydration and increased serum osmolality. However, altered mental status is usually more severe in HHS, as it typically develops gradually over several days, leading to profound hyperosmolarity and cerebral dehydration.
Serum bicarbonate less than 15 mEq/L – DKA:
A low bicarbonate level indicates metabolic acidosis, which occurs in DKA due to the accumulation of acidic ketone bodies. In contrast, clients with HHS maintain normal or near-normal bicarbonate levels because ketosis and acidosis are minimal. This lab value helps differentiate DKA from HHS.
Physiological stressor as precipitating factor – DKA and HHS:
Both conditions are commonly triggered by physiological stressors such as infections, illness, trauma, or surgery. These stressors increase cortisol and catecholamine release, raising blood glucose levels and worsening insulin deficiency or resistance. In both DKA and HHS, addressing the underlying stressor is essential to prevent recurrence.
A nurse is caring for a client who reports increased anxiety and nervousness, heat intolerance, and unintentional weight loss. Blood testing reveals decreased thyroid-stimulating hormone (TSH), elevated thyroxine (T4), and elevated triiodothyronine (T3) levels. Which of the following vital sign abnormalities does the nurse anticipate?
- A. Decreased body temperature
- B. Slow respiratory rate
- C. Hypotension
- D. Tachycardia
Explanation
The client’s laboratory results and symptoms indicate hyperthyroidism, specifically an overproduction of thyroid hormones (T3 and T4) and suppression of TSH. These hormones accelerate the body’s metabolic rate, leading to symptoms such as heat intolerance, anxiety, tremors, and tachycardia due to increased oxygen demand and heightened sympathetic nervous system activity. Persistent tachycardia is a hallmark finding and, if untreated, can progress to cardiac arrhythmias or heart failure.
A nurse is providing care for a client diagnosed with diabetic ketoacidosis (DKA). Which of the following characteristics are associated with DKA? (Select All that Apply.)
- A. Ketosis
- B. Low blood sugar
- C. Fluid overload
- D. Alkalosis
- E. Acidosis
- F. Hyperglycemia
Explanation
Explanation of Correct Answers
A. Ketosis:
In DKA, the body cannot use glucose for energy due to insulin deficiency, leading to fat breakdown for fuel. This process produces ketones, which accumulate in the blood and urine. The presence of ketones is a hallmark of DKA and contributes to the metabolic acidosis seen in this condition.
E. Acidosis:
Excess ketone production leads to a drop in blood pH, resulting in metabolic acidosis. Clients often exhibit Kussmaul respirations as the body attempts to compensate by blowing off carbon dioxide. Acidosis must be corrected gradually with insulin and fluids.
F. Hyperglycemia:
DKA is characterized by severely elevated blood glucose levels, often exceeding 300 mg/dL. Insulin deficiency prevents glucose uptake into cells, causing glucose accumulation in the bloodstream. Hyperglycemia leads to osmotic diuresis, dehydration, and electrolyte imbalances requiring prompt medical management.
Which four findings are most concerning? (Select All that Apply.)
- A. Ammonia
- B. ALT
- C. AST
- D. Blood pressure
- E. Platelets
- F. Hemoglobin
Explanation
Explanation of Correct Answers
A. Ammonia:
An ammonia level of 94 μmol/L (normal <30) is critically elevated and indicates impaired liver detoxification, consistent with hepatic encephalopathy. Elevated ammonia crosses the blood-brain barrier, leading to confusion, lethargy, and altered mental status. Immediate treatment with lactulose or rifaximin is required to reduce ammonia absorption and prevent progression to coma.
D. Blood pressure:
A blood pressure of 87/42 mm Hg reflects hypotension, suggesting possible circulatory collapse or hemorrhagic shock, likely related to liver dysfunction or gastrointestinal bleeding (common in liver failure). Hypotension compromises organ perfusion, including to the kidneys and brain, and requires immediate fluid resuscitation or vasopressor support.
E. Platelets:
A platelet count of 100 ×10³/μL (normal 150–450) indicates thrombocytopenia, commonly seen in liver failure due to splenomegaly or decreased hepatic synthesis of clotting factors. This significantly increases the risk for spontaneous bleeding, especially in the GI tract or from varices, making it a priority concern.
F. Hemoglobin:
A hemoglobin of 6 g/dL (normal 12–16) is critically low and suggests severe anemia, potentially due to internal bleeding or chronic disease. Such a low level severely reduces oxygen-carrying capacity, causing tachycardia and hypotension. Immediate blood transfusion and monitoring for active bleeding are indicated.
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