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 ascites secondary to liver dysfunction. Which of the following interventions are appropriate for a client experiencing complications of ascites? (Select All that Apply.)
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Administer diuretic medications as prescribed
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Initiate dialysis
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Paracentesis
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Albumin
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Encourage the client to lie flat on their back
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Administer opioid pain medications
Explanation
Explanation of Correct Answers
A. Administer diuretic medications as prescribed
Diuretics such as spironolactone and furosemide are used to promote fluid excretion and reduce abdominal swelling associated with ascites. By decreasing total body fluid and sodium retention, they help relieve discomfort and lower the risk of respiratory compromise caused by abdominal distention.
C. Paracentesis
Paracentesis is a procedure that removes excess ascitic fluid from the peritoneal cavity using a needle or catheter. It is indicated when ascites causes severe abdominal distention, pain, or respiratory distress. This procedure provides immediate symptom relief and can improve breathing and comfort.
D. Albumin
Albumin administration after paracentesis helps maintain intravascular volume and prevent circulatory collapse. In clients with liver dysfunction, low albumin levels contribute to fluid leakage into the abdomen, so albumin infusion helps restore oncotic pressure and stabilize blood pressure.
A nurse is caring for a client who has an admitted diagnosis of renal calculi and a medical history of hypertension and gout. The client works 6 days a week outside in temperatures between 32.2° C to 37.8° C (90° F to 100° F). Which of the following should the nurse tell the client to prevent a reoccurrence of renal calculi?
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Drink plenty of fluids during the day.
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Eat a diet high in calcium oxalate–rich foods.
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Eat a diet high in purine-rich foods.
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Continue to take your prescribed gout medication.
Explanation
Adequate hydration is the most important measure to prevent recurrence of renal calculi (kidney stones). Working in high temperatures leads to fluid loss through perspiration, concentrating the urine and promoting crystal formation. Drinking plenty of fluids—ideally enough to produce at least 2 liters of urine per day—dilutes the urine and reduces the risk of stone formation, especially in individuals with gout, where uric acid levels may be elevated.
A nurse is assessing an older adult client who has just been admitted to the medical-surgical unit and presents with a large amount of abdominal ascites. The client is alert and oriented ×3 and states that they walk independently at home and normally use a cane but forgot to bring it to the hospital. Which of the following should be a priority action implemented by the nurse?
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Fall risk protocol
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Sodium restriction diet
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Skin safety protocol
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Bleeding precaution protocol
Explanation
The presence of large abdominal ascites alters the client’s center of gravity, impairs balance, and increases the risk of falls, especially in an older adult who already relies on a cane for mobility. Since the client does not currently have their assistive device, implementing a fall risk protocol is the top priority to ensure immediate safety. This includes providing assistance with ambulation, ensuring the call light is within reach, using nonslip footwear, and possibly arranging a walker or cane while hospitalized. Preventing falls takes precedence before addressing other long-term or secondary issues.
A nurse is providing care for several clients who have type 1 diabetes mellitus. Which of the following clients is most at risk for developing diabetic ketoacidosis (DKA)?
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A client who is awaiting cataract surgery
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A client who is being evaluated for a breast lump
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A client who is receiving IV antibiotics for a urinary tract infection
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A client with a history of Grave’s disease
Explanation
Infection is the most common precipitating factor for diabetic ketoacidosis (DKA) in clients with type 1 diabetes. During infection, the body releases stress hormones such as cortisol and catecholamines, which increase glucose production and reduce insulin effectiveness. This leads to hyperglycemia, fat breakdown, and ketone production, resulting in metabolic acidosis. A client with a urinary tract infection who is receiving IV antibiotics is therefore at the highest risk for developing DKA, especially if insulin doses are missed or poorly absorbed due to illness.
A nurse is caring for a client following a motor vehicle accident. The client has a history of Grave’s disease. The client develops a fever of 40.6°C (105°F), has a heart rate of 155/min, and a blood pressure of 70/30 mm Hg. Which of the following alterations does the nurse suspect?
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Hyperglycemia
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Metabolic syndrome
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Thyroid storm
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Diabetic retinopathy
Explanation
Thyroid storm is a life-threatening complication of Grave’s disease (severe hyperthyroidism), often triggered by physical stressors such as trauma, surgery, or infection. It results from excessive release of thyroid hormones, leading to severe hypermetabolism. The hallmark findings include high fever (≥40°C/104°F), extreme tachycardia (>140/min), and hypotension due to cardiovascular collapse. Additional manifestations include anxiety, tremors, diaphoresis, and altered mental status. Immediate management includes antithyroid medications (propylthiouracil or methimazole), beta-blockers (propranolol), IV fluids, and cooling measures.
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)?
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Polyuria/polydipsia – DKA and HHS
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Kussmaul respirations – DKA
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Altered mental status – DKA and HHS
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Serum bicarbonate less than 15 mEq/L – DKA
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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.
The nurse teaches a client about portal hypertension. Which client statement indicates teaching was effective?
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"Portal hypertension means fast-spreading high blood pressure. It causes red veins on my arms."
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"Portal hypertension means high blood pressure throughout my abdomen. It causes me to feel confused."
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"In portal hypertension, blood backs up in the liver. It redistributes to lower pressure areas and can cause enlarged blood vessels in my esophagus."
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"In portal hypertension, blood leaks from my liver. It causes me to feel hungry frequently."
Explanation
Portal hypertension occurs when blood flow through the liver is obstructed, often due to cirrhosis, causing increased pressure in the portal venous system. As a result, blood is redirected to collateral veins in lower-pressure areas such as the esophagus, stomach, and rectum. This leads to the development of esophageal or gastric varices, which are prone to rupture and life-threatening bleeding. The client’s statement correctly explains the mechanism and consequence of portal hypertension.
A nurse is caring for an older adult client who has just been admitted to the intensive care unit with a diagnosis of confusion/delirium. The client has an end-stage liver failure diagnosis with increasing ascites. Their spouse questions the nurse about the client’s mental status because they state that the client is usually lucid. Which of the following indications is likely the contributing factor for the admitting diagnosis?
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"This is likely related to new-onset dementia."
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"This is likely related to new-onset hepatic encephalopathy."
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"This is likely related to a new-onset UTI."
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"This is likely related to a new-onset schizophrenia."
Explanation
In clients with end-stage liver failure, the liver cannot effectively detoxify ammonia and other byproducts of protein metabolism. The accumulation of ammonia in the bloodstream crosses the blood-brain barrier, causing hepatic encephalopathy, which manifests as confusion, disorientation, and altered level of consciousness. This is a common complication of severe liver disease and is often precipitated by gastrointestinal bleeding, infection, constipation, or electrolyte imbalance. Prompt recognition and treatment with lactulose or rifaximin can reduce ammonia levels and improve mental status.
A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect?
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pH 7.25, HCO3− 19 mEq/L, PaCO2 30 mm Hg
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pH 7.30, HCO3− 26 mEq/L, PaCO2 50 mm Hg
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pH 7.50, HCO3− 20 mEq/L, PaCO2 32 mm Hg
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pH 7.55, HCO3− 30 mEq/L, PaCO2 31 mm Hg
Explanation
Chronic kidney disease commonly causes metabolic acidosis due to reduced renal acid excretion and impaired bicarbonate regeneration. The expected ABG shows acidemia (pH < 7.35) with a low bicarbonate and an appropriately decreased PaCO2 from respiratory compensation (Kussmaul-type ventilation). Option A reflects this pattern: low pH and low HCO3− with compensatory hypocapnia. By contrast, B indicates primary respiratory acidosis, C shows respiratory alkalosis, and D indicates metabolic alkalosis, none typical of CKD.
A nurse is teaching a client who has hepatitis A. Which of the following information should the nurse include?
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A family history increases your risk for acquiring hepatitis A.
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Hepatitis A infects the kidneys.
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The incubation of the virus is 5 days.
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Manifestations of the virus are similar to flu-like symptoms.
Explanation
Hepatitis A is an acute viral infection that primarily affects the liver and is transmitted via the fecal-oral route, often through contaminated food or water. The early symptoms resemble those of influenza and include fatigue, malaise, anorexia, nausea, vomiting, fever, and right upper quadrant discomfort. Jaundice may develop later as liver inflammation progresses. The infection is usually self-limiting and does not cause chronic liver disease. Preventive measures include proper hand hygiene and vaccination.
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