ATI Custom: AH2- FA25- Exam 3
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Free ATI Custom: AH2- FA25- Exam 3 Questions
A nurse remains with a client to observe for any adverse reactions after initiating a transfusion of packed RBCs. The client becomes apprehensive and tachycardic, reporting headache and low back pain. The nurse should recognize that these findings indicate which of the following transfusion reactions?
- A. Allergic
- B. Febrile
- C. Hemolytic
- D. Bacterial
Explanation
A hemolytic transfusion reaction occurs when the recipient’s immune system attacks incompatible donor red blood cells, causing their destruction. Early signs include anxiety, tachycardia, headache, low back or flank pain, fever, chills, and hypotension. These symptoms result from hemolysis and the release of hemoglobin into circulation, which can lead to acute renal failure and shock. Immediate actions include stopping the transfusion, maintaining IV access with normal saline, and notifying the provider and blood bank.
A nurse is caring for a patient with diabetic ketoacidosis (DKA) who is prescribed an intravenous insulin drip. The nurse is monitoring the patient closely. Which of the following findings should the nurse prioritize and anticipate as potential complications? (Select All that Apply.)
- A. Bradycardia and hypertension
- B. Hypocalcemia
- C. Respiratory alkalosis
- D. Decreased level of consciousness
- E. Kussmaul respirations
- F. Alkalosis
- G. Metabolic alkalosis
- H. Hyperkalemia
Explanation
Explanation of Correct Answers
D. Decreased level of consciousness
A declining level of consciousness occurs as acidosis worsens and dehydration, hyperosmolarity, and electrolyte disturbances impair cerebral function. If untreated, this can progress to diabetic coma. Frequent neurological assessments are critical to monitor for signs of cerebral edema during treatment, particularly as glucose levels fall.
E. Kussmaul respirations
Kussmaul respirations are deep, rapid breathing patterns seen in metabolic acidosis, a key feature of DKA. The body attempts to blow off carbon dioxide to compensate for the low pH caused by ketone accumulation. This respiratory compensation is an early sign of severe acidosis and should be closely monitored for changes as insulin corrects the underlying cause.
H. Hyperkalemia
At presentation, DKA often causes hyperkalemia due to insulin deficiency and acidosis, which shift potassium from cells into the bloodstream. Although total body potassium is low from urinary loss, serum levels may be elevated initially. As insulin therapy and acidosis correction begin, potassium levels drop rapidly, increasing the risk for dangerous hypokalemia if not monitored and supplemented appropriately.
A nurse is caring for a client with ascites caused by liver failure. Which of the following should the nurse report for immediate follow-up?
- A. Jaundice
- B. Dyspnea
- C. Increased abdominal girth
- D. Irregular menses
Explanation
Dyspnea (difficulty breathing) in a client with ascites requires immediate follow-up because it may indicate respiratory compromise caused by excessive abdominal fluid pressing upward on the diaphragm. This increased intra-abdominal pressure restricts lung expansion, leading to decreased oxygenation and potential respiratory distress. The nurse should promptly assess oxygen saturation, position the client in high Fowler’s position, and notify the healthcare provider. Paracentesis or diuretic therapy may be required to relieve pressure and improve breathing.
A nurse is caring for a client who has a history of alcohol use disorder and reports bruising and frequent nosebleeds. The nurse should recognize that this client is manifesting which of the following conditions?
- A. Cirrhosis
- B. Diabetes
- C. Hepatitis A
- D. Malnutrition
Explanation
Cirrhosis is a chronic liver condition often caused by long-term alcohol abuse that leads to fibrosis and scarring of liver tissue. The liver normally produces clotting factors that are essential for blood coagulation. When the liver becomes damaged, production of these clotting factors decreases, resulting in easy bruising, frequent nosebleeds, and prolonged bleeding. Additionally, cirrhosis can cause thrombocytopenia due to splenic sequestration, further worsening bleeding tendencies.
A nurse is assessing a client who is experiencing thyroid storm. Which of the following findings should the nurse anticipate?
- A. Coma
- B. Fruity smelling breath
- C. Hypothermia
- D. Tachycardia
Explanation
Thyroid storm is a life-threatening complication of uncontrolled hyperthyroidism characterized by excessive thyroid hormone release, leading to severe hypermetabolism. The nurse should anticipate tachycardia, often exceeding 130 beats per minute, as the cardiovascular system becomes overstimulated. Additional findings include high fever, hypertension, anxiety, tremors, diaphoresis, and restlessness. Without prompt treatment—such as beta-blockers, antithyroid medications, and cooling measures—the condition can progress to heart failure, shock, or death.
A nurse is caring for a client who has end-stage kidney disease who will soon begin hemodialysis treatments. Which of the following restrictions should the nurse discuss with the client that may impact quality of life? (Select All that Apply.)
- A. Restricting fluid intake
- B. Driving restrictions
- C. Restricting airplane travel
- D. Restricting foods high in potassium, sodium, and phosphorus
- E. Limiting social activities to twice a week
- F. Time constraints associated with hemodialysis treatment
Explanation
Explanation of Correct Answers
A. Restricting fluid intake
Clients on hemodialysis must limit fluid intake because the kidneys can no longer eliminate excess water efficiently. Excessive fluid can cause hypertension, pulmonary edema, and heart failure. This restriction can affect social experiences and comfort, particularly in hot weather or social situations involving beverages.
D. Restricting foods high in potassium, sodium, and phosphorus
Dietary restrictions are crucial in hemodialysis to prevent dangerous electrolyte imbalances. High potassium foods (bananas, oranges, potatoes), high sodium foods (processed meats, canned soups), and high phosphorus foods (dairy, nuts) must be limited, which can make meal planning difficult and impact quality of life.
F. Time constraints associated with hemodialysis treatment
Hemodialysis typically requires 3–4 sessions per week, each lasting 3–5 hours, limiting work, travel, and social opportunities. The need for transportation and scheduling around treatments often disrupts daily routines and independence.
A nurse is reviewing laboratory findings for four clients. Which of the following clients has manifestations of acute kidney injury?
- A. Hemoglobin 16 g/dL
- B. Serum creatinine 6 mg/dL
- C. Serum potassium 4.5 mEq/L
- D. BUN 15 mg/dL
Explanation
A serum creatinine level of 6 mg/dL is markedly elevated and indicates acute kidney injury (AKI). Creatinine is a waste product filtered by the kidneys, and when renal function declines, creatinine accumulates in the blood. This rise reflects impaired glomerular filtration and decreased excretion capability. Clients with AKI often exhibit oliguria, fluid retention, and electrolyte imbalances such as hyperkalemia. Prompt treatment focuses on identifying and reversing the underlying cause while preventing further renal damage.
The nurse notes new areas of ecchymosis on the arms and legs of a client with cirrhosis. Which laboratory test result should the nurse monitor because of this finding? (Select All that Apply.)
- A. B-natriuretic peptide
- B. Troponin
- C. Coagulation studies
- D. Serum ammonia
- E. Complete blood count
Explanation
Explanation of Correct Answers
C. Coagulation studies
Clients with cirrhosis often have impaired liver function, which affects the liver’s ability to synthesize clotting factors (such as fibrinogen, prothrombin, and factors II, VII, IX, and X). This leads to an increased prothrombin time (PT) and INR, predisposing the client to easy bruising and bleeding. Monitoring coagulation studies helps evaluate bleeding risk and the need for vitamin K or plasma transfusion.
E. Complete blood count
A CBC helps assess for thrombocytopenia, a common finding in cirrhosis due to splenic sequestration from portal hypertension and reduced thrombopoietin production by the liver. Low platelet levels contribute to bruising (ecchymosis) and increase the risk of spontaneous bleeding.
A nurse is caring for a client who recently started treatment for Stage I Hodgkin’s lymphoma and describes the following to the nurse: “My arms and hands feel so tight and heavy. I can’t put my ring on and I’m having trouble doing everyday things around the house because my fingers won’t move normally.” The nurse should understand that the client is experiencing which of the following complications associated with cancer and cancer treatments?
- A. Peripheral neuropathy
- B. Lymphedema
- C. Fatigue
- D. Mucositis
Explanation
Lymphedema is a common complication of lymph node removal or radiation therapy, often seen in clients treated for Hodgkin’s lymphoma, breast cancer, or other cancers involving lymphatic structures. It results from impaired lymphatic drainage, leading to accumulation of lymph fluid in the interstitial tissues. This causes swelling, tightness, heaviness, and decreased mobility in the affected limb. Management includes elevating the arm, performing range-of-motion exercises, using compression garments, and avoiding blood draws or BP measurements on the affected side.
A client with history of end stage renal disease presents to the ED. Upon gathering a history, the nurse finds that the client has missed hemodialysis for a week. The nurse sees the following on the cardiac monitor and is concerned for which lab abnormality?
- A. Hyperalbuminemia
- B. Hypermagnesemia
- C. Hyperkalemia
- D. Hypoglycemia
Explanation
The ECG strip in the question shows tall, peaked T waves, which are classic for hyperkalemia. Clients with end-stage renal disease (ESRD) who miss dialysis treatments are unable to excrete potassium effectively, leading to dangerously elevated serum potassium levels. High potassium disrupts cardiac electrical conduction, causing tall peaked T waves, widened QRS complexes, and prolonged PR intervals — which can progress to ventricular fibrillation or asystole if not treated promptly.
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