ATI Custom: AH2- FA25- Exam 3
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Free ATI Custom: AH2- FA25- Exam 3 Questions
1.
A nurse is reviewing laboratory findings for four clients. Which of the following clients has manifestations of acute kidney injury?
- Hemoglobin 16 g/dL
- Serum creatinine 6 mg/dL
- Serum potassium 4.5 mEq/L
- BUN 15 mg/dL
Explanation
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.
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.
2.
A nurse is educating a client about preventative health. Which of the following are considered risk factors for cancer? (Select All that Apply.)
- Smoking
- Vaccinations
- Fruit and vegetable consumption
- Sun exposure
- Exercise
- Alcohol consumption
- Age
- Obesity
- I. Environmental factors
- J. Genetics
Explanation
Explanation
Explanation of Correct Answers
A. Smoking:
Smoking is one of the leading preventable causes of cancer worldwide. Tobacco contains numerous carcinogenic substances that damage cell DNA and promote mutations. Prolonged smoking increases the risk of cancers of the lungs, throat, mouth, esophagus, bladder, kidney, pancreas, and cervix. Even secondhand smoke exposure carries significant risk for non-smokers. Quitting smoking significantly reduces cancer risk over time.
D. Sun exposure:
Excessive sun exposure, particularly without protection, exposes the skin to ultraviolet (UV) radiation that damages cellular DNA. Over time, this damage can cause mutations leading to skin cancers such as basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. Preventive measures include wearing sunscreen, protective clothing, and avoiding tanning beds or peak sun hours.
F. Alcohol consumption:
Chronic or excessive alcohol intake increases cancer risk because alcohol and its metabolite, acetaldehyde, are toxic to cells. Alcohol also impairs nutrient absorption and alters hormone levels, contributing to cancers of the mouth, throat, liver, breast, and colon. Reducing or eliminating alcohol consumption lowers this risk.
G. Age:
The risk of developing cancer increases with age due to cumulative exposure to carcinogens, a lifetime of cellular replication errors, and a decline in immune surveillance. Older adults are more susceptible because their cells have had more opportunities to acquire mutations that lead to malignancy.
H. Obesity:
Obesity contributes to chronic inflammation and hormonal imbalances, such as elevated estrogen and insulin levels, which promote tumor growth. Obesity is linked to breast, colon, uterine, pancreatic, and kidney cancers. Weight management through a healthy diet and regular physical activity is crucial in reducing cancer risk.
I. Environmental factors:
Exposure to harmful environmental agents like asbestos, benzene, pesticides, radiation, and industrial chemicals increases cancer risk. Chronic exposure to these carcinogens leads to cellular injury and mutations. Protective measures include workplace safety protocols, using protective equipment, and minimizing contact with known toxins.
J. Genetics:
Inherited mutations in certain genes, such as BRCA1, BRCA2, and TP53, increase susceptibility to cancers including breast, ovarian, and colorectal cancer. While these mutations cannot be prevented, early screening, genetic counseling, and preventive treatments can help reduce mortality through early detection and management.
Explanation of Correct Answers
A. Smoking:
Smoking is one of the leading preventable causes of cancer worldwide. Tobacco contains numerous carcinogenic substances that damage cell DNA and promote mutations. Prolonged smoking increases the risk of cancers of the lungs, throat, mouth, esophagus, bladder, kidney, pancreas, and cervix. Even secondhand smoke exposure carries significant risk for non-smokers. Quitting smoking significantly reduces cancer risk over time.
D. Sun exposure:
Excessive sun exposure, particularly without protection, exposes the skin to ultraviolet (UV) radiation that damages cellular DNA. Over time, this damage can cause mutations leading to skin cancers such as basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. Preventive measures include wearing sunscreen, protective clothing, and avoiding tanning beds or peak sun hours.
F. Alcohol consumption:
Chronic or excessive alcohol intake increases cancer risk because alcohol and its metabolite, acetaldehyde, are toxic to cells. Alcohol also impairs nutrient absorption and alters hormone levels, contributing to cancers of the mouth, throat, liver, breast, and colon. Reducing or eliminating alcohol consumption lowers this risk.
G. Age:
The risk of developing cancer increases with age due to cumulative exposure to carcinogens, a lifetime of cellular replication errors, and a decline in immune surveillance. Older adults are more susceptible because their cells have had more opportunities to acquire mutations that lead to malignancy.
H. Obesity:
Obesity contributes to chronic inflammation and hormonal imbalances, such as elevated estrogen and insulin levels, which promote tumor growth. Obesity is linked to breast, colon, uterine, pancreatic, and kidney cancers. Weight management through a healthy diet and regular physical activity is crucial in reducing cancer risk.
I. Environmental factors:
Exposure to harmful environmental agents like asbestos, benzene, pesticides, radiation, and industrial chemicals increases cancer risk. Chronic exposure to these carcinogens leads to cellular injury and mutations. Protective measures include workplace safety protocols, using protective equipment, and minimizing contact with known toxins.
J. Genetics:
Inherited mutations in certain genes, such as BRCA1, BRCA2, and TP53, increase susceptibility to cancers including breast, ovarian, and colorectal cancer. While these mutations cannot be prevented, early screening, genetic counseling, and preventive treatments can help reduce mortality through early detection and management.
3.
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?
- Hyperalbuminemia
- Hypermagnesemia
- Hyperkalemia
- Hypoglycemia
Explanation
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.
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.
4.
For each finding below, determine whether it is most consistent with Ascites or Elevated Ammonia.
- Increased abdominal girth
- Agitation
- Shortness of breath
- Peripheral edema
- Low serum albumin
- Altered mental status
Explanation
Explanation
Correct Associations:
A. Increased abdominal girth – Ascites
B. Agitation – Elevated ammonia
C. Shortness of breath – Ascites
D. Peripheral edema – Ascites
E. Low serum albumin – Ascites
F. Altered mental status – Elevated ammonia
Explanation of Correct Answers
A. Increased abdominal girth – Ascites:
Ascites occurs due to fluid accumulation in the abdominal cavity from portal hypertension and low albumin levels. This leads to noticeable abdominal distention and discomfort, as seen in clients with liver failure.
B. Agitation – Elevated ammonia:
An elevated ammonia level (94 μmol/L) reflects hepatic encephalopathy, in which ammonia buildup affects brain function. Clients often exhibit agitation, restlessness, or irritability that may progress to confusion or coma if untreated.
C. Shortness of breath – Ascites:
The buildup of ascitic fluid pushes upward on the diaphragm, restricting lung expansion. This mechanical pressure leads to dyspnea, tachypnea, and labored respirations, consistent with the client’s presentation.
D. Peripheral edema – Ascites:
Fluid retention and decreased oncotic pressure from hypoalbuminemia cause swelling in the legs and feet. Portal hypertension further exacerbates venous congestion, leading to dependent edema.
E. Low serum albumin – Ascites:
A low albumin level (20 g/L) indicates impaired liver protein synthesis. Reduced albumin decreases oncotic pressure, allowing fluid to leak into the peritoneal cavity and contribute to ascites formation.
F. Altered mental status – Elevated ammonia:
Ammonia toxicity from liver dysfunction causes neurological symptoms such as confusion, disorientation, and lethargy. The client’s change in orientation from baseline is consistent with hepatic encephalopathy secondary to elevated ammonia levels.
Correct Associations:
A. Increased abdominal girth – Ascites
B. Agitation – Elevated ammonia
C. Shortness of breath – Ascites
D. Peripheral edema – Ascites
E. Low serum albumin – Ascites
F. Altered mental status – Elevated ammonia
Explanation of Correct Answers
A. Increased abdominal girth – Ascites:
Ascites occurs due to fluid accumulation in the abdominal cavity from portal hypertension and low albumin levels. This leads to noticeable abdominal distention and discomfort, as seen in clients with liver failure.
B. Agitation – Elevated ammonia:
An elevated ammonia level (94 μmol/L) reflects hepatic encephalopathy, in which ammonia buildup affects brain function. Clients often exhibit agitation, restlessness, or irritability that may progress to confusion or coma if untreated.
C. Shortness of breath – Ascites:
The buildup of ascitic fluid pushes upward on the diaphragm, restricting lung expansion. This mechanical pressure leads to dyspnea, tachypnea, and labored respirations, consistent with the client’s presentation.
D. Peripheral edema – Ascites:
Fluid retention and decreased oncotic pressure from hypoalbuminemia cause swelling in the legs and feet. Portal hypertension further exacerbates venous congestion, leading to dependent edema.
E. Low serum albumin – Ascites:
A low albumin level (20 g/L) indicates impaired liver protein synthesis. Reduced albumin decreases oncotic pressure, allowing fluid to leak into the peritoneal cavity and contribute to ascites formation.
F. Altered mental status – Elevated ammonia:
Ammonia toxicity from liver dysfunction causes neurological symptoms such as confusion, disorientation, and lethargy. The client’s change in orientation from baseline is consistent with hepatic encephalopathy secondary to elevated ammonia levels.
5.
Which of the following instructions is essential for a client to follow when caring for a PICC line at home?
- Flush the PICC line with saline before and after medication administration.
- Use scissors to remove the PICC line dressing.
- Change the PICC line dressing every 72 hours.
- Only wash hands before touching the PICC line if they appear dirty.
Explanation
Explanation
Flushing the PICC line with saline before and after medication administration is essential to maintain catheter patency and prevent occlusion. It also helps to clear residual medication, reducing the risk of drug incompatibility or infection. Using sterile technique during flushing is critical to prevent contamination. Regular flushing as prescribed ensures proper functioning of the line and reduces the risk of complications such as clot formation or catheter blockage.
Flushing the PICC line with saline before and after medication administration is essential to maintain catheter patency and prevent occlusion. It also helps to clear residual medication, reducing the risk of drug incompatibility or infection. Using sterile technique during flushing is critical to prevent contamination. Regular flushing as prescribed ensures proper functioning of the line and reduces the risk of complications such as clot formation or catheter blockage.
6.
A nurse is teaching a client who has chronic kidney failure about planning a low-protein diet. The client states, "Why do I have to be concerned about protein?" Which of the following responses should the nurse make?
- "A low-protein diet reduces the risk for edema."
- "A low-protein diet will increase the nitrogenous wastes in the blood."
- "A low-protein diet reduces the risk for uremia."
- "A low-protein diet will reduce the risk for hyperkalemia."
Explanation
Explanation
In chronic kidney failure, the kidneys lose their ability to effectively excrete urea and other nitrogenous wastes produced from protein metabolism. Consuming excessive protein increases the production of these waste products, which accumulate in the bloodstream and lead to uremia—manifested by nausea, vomiting, fatigue, and confusion. A low-protein diet helps decrease urea production, reducing symptoms and slowing progression of kidney damage, while maintaining adequate nutrition through high-biological-value proteins such as eggs and milk.
In chronic kidney failure, the kidneys lose their ability to effectively excrete urea and other nitrogenous wastes produced from protein metabolism. Consuming excessive protein increases the production of these waste products, which accumulate in the bloodstream and lead to uremia—manifested by nausea, vomiting, fatigue, and confusion. A low-protein diet helps decrease urea production, reducing symptoms and slowing progression of kidney damage, while maintaining adequate nutrition through high-biological-value proteins such as eggs and milk.
7.
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?
- Jaundice
- Dyspnea
- Increased abdominal girth
- Irregular menses
Explanation
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.
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.
8.
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.)
- B-natriuretic peptide
- Troponin
- Coagulation studies
- Serum ammonia
- Complete blood count
Explanation
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.
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.
9.
The nurse teaches a client about portal hypertension. Which client statement indicates teaching was effective?
- "Portal hypertension means fast-spreading high blood pressure. It causes red veins on my arms."
- "Portal hypertension means high blood pressure throughout my abdomen. It causes me to feel confused."
- "In portal hypertension, blood backs up in the liver. It redistributes to lower pressure areas and can cause enlarged blood vessels in my esophagus."
- "In portal hypertension, blood leaks from my liver. It causes me to feel hungry frequently."
Explanation
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.
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.
10.
A nurse is educating a group of clients about complications of alcohol abuse. Which of the following best describes cirrhosis in layman’s terms?
- A type of cancer that originates in the liver
- A condition in which the liver becomes scarred and cannot function properly
- A virus that affects the liver and causes inflammation
- A genetic disorder that affects the liver and impairs its ability to process fats
Explanation
Explanation
Cirrhosis is a chronic, progressive condition in which healthy liver tissue is replaced by scar tissue, usually from long-term damage such as alcohol abuse, hepatitis, or fatty liver disease. This scarring blocks blood flow through the liver and impairs its ability to filter toxins, produce proteins, and process nutrients. Over time, cirrhosis can lead to liver failure and life-threatening complications like jaundice, ascites, and bleeding.
Cirrhosis is a chronic, progressive condition in which healthy liver tissue is replaced by scar tissue, usually from long-term damage such as alcohol abuse, hepatitis, or fatty liver disease. This scarring blocks blood flow through the liver and impairs its ability to filter toxins, produce proteins, and process nutrients. Over time, cirrhosis can lead to liver failure and life-threatening complications like jaundice, ascites, and bleeding.
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