ATI Custom NUR 2610 Exam 4 Version 1
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Free ATI Custom NUR 2610 Exam 4 Version 1 Questions
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Notify the client's provider after completing the transfusion.
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Stop the transfusion immediately and maintain IV access with normal saline.
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Slow the transfusion rate and continue monitoring the client.
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Administer antihistamines and continue the transfusion.
Explanation
Correct Answer: (B) Stop the transfusion immediately and maintain IV access with normal saline.
Itching, anxiety, and shortness of breath during a blood transfusion are classic signs of a transfusion reaction, which can rapidly progress to anaphylaxis. The nurse's priority is to stop the transfusion immediately to prevent further exposure to the offending blood product, then maintain IV access with normal saline to keep the line open for emergency medications. The blood bag and tubing are then sent to the lab and the provider is notified.
Why other options are incorrect:
A. Completing the transfusion before notifying the provider is dangerous and could be fatal, as continued infusion worsens the reaction.
C. Slowing the rate is insufficient; any signs of a transfusion reaction require immediate cessation, not rate adjustment.
D. Administering antihistamines and continuing the transfusion is inappropriate; the transfusion must be stopped first before any medications are administered.
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Encourage the client to take frequent short walks.
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Elevate the legs above heart level several times a day.
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Instruct the client to place their legs in a dependent position when sitting.
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Apply compression stockings before activity.
Explanation
Correct Answer: (C) Instruct the client to place their legs in a dependent position when sitting.
In PAD, arterial blood flow to the lower extremities is impaired. Placing the legs in a dependent position uses gravity to assist arterial blood flow to the feet and legs, helping to relieve ischemic pain known as intermittent claudication.
Why other options are incorrect:
A. Frequent short walks are encouraged as part of long-term PAD management to build collateral circulation, but during an episode of pain, rest is first needed before resuming activity.
B. Elevating the legs above heart level is appropriate for venous insufficiency, not PAD. Elevation worsens arterial flow in PAD by working against gravity.
D. Compression stockings are contraindicated in PAD as they further restrict arterial blood flow to already ischemic tissue.
History and Physical
1000:
Client admitted to the ED with chest tightness radiating to jaw since 0600. Client is diaphoretic and appears anxious. Client reports chest tightness not relieved with rest, and periods of nausea, dizziness, and palpitations. Client reports history of hypertension and hyperlipidemia. Client is awake, alert and oriented to person, time, and place. Bilateral breath sounds clear and present throughout.
Select the 3 findings below that indicate the client is not progressing as expected.
- Anticipated
- Nonessential
- Contraindicated
Explanation
Correct Answer: A. Anticipated Nitroglycerin is a first-line treatment for ischemic chest pain, promoting coronary vasodilation and reducing myocardial oxygen demand.
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Begin mammograms and breast MRIs by age 25–30.
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Annual mammograms starting at age 50.
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Limit screenings to ultrasound for dense breast tissue.
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Avoid screenings to prevent unnecessary radiation exposure.
Explanation
Correct Answer: (A) Begin mammograms and breast MRIs by age 25–30.
Clients with a BRCA1 gene mutation have a significantly elevated lifetime risk of breast cancer. Current guidelines recommend that high-risk individuals begin annual mammograms and breast MRIs earlier than the general population, typically between ages 25–30, to enable early detection and improve outcomes.
Why the other options are incorrect:
B. Annual mammograms starting at age 50 follows the general population screening guideline and is insufficient for a high-risk BRCA1 client who requires earlier and more frequent screening.
C. Limiting screenings to ultrasound alone is inadequate; MRI combined with mammography provides the most comprehensive surveillance for BRCA1 mutation carriers.
D. Avoiding screenings is dangerous for a high-risk client. The benefit of early detection far outweighs the minimal radiation risk from mammography.
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Monitoring blood glucose levels
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Encouraging fluid intake
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Administering anticoagulant therapy
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Performing deep breathing exercises
Explanation
Correct Answer: (D) Performing deep breathing exercises.
After CABG surgery, clients are at high risk for atelectasis due to general anesthesia, prolonged immobility, and chest wall pain that inhibits deep breathing. Deep breathing exercises, along with incentive spirometry and early ambulation, expand the alveoli, promote gas exchange, and prevent collapse of lung tissue.
Why the other options are incorrect:
A. Monitoring blood glucose is important post-surgery but does not directly prevent atelectasis.
B. Encouraging fluid intake supports hydration and secretion clearance but is not the primary intervention for atelectasis prevention.
C. Anticoagulant therapy is used to prevent thromboembolism post-CABG, not to prevent atelectasis.
History and Physical
1000:
Client admitted to the ED with chest tightness radiating to jaw since 0600. Client is diaphoretic and appears anxious. Client reports chest tightness not relieved with rest, and periods of nausea, dizziness, and palpitations. Client reports history of hypertension and hyperlipidemia. Client is awake, alert and oriented to person, time, and place. Bilateral breath sounds clear and present throughout. Apical pulse regular, and rapid. Feet cool, pedal pulses diminished, equal at 1+ bilaterally.
For each potential provider's prescription, specify if the potential prescription is anticipated, nonessential, or contraindicated for the client.
Obtain a referral for a speech therapist
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Anticipated
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Nonessential
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Contraindicated
Explanation
Correct Answer: B. Nonessential There is no indication of swallowing difficulties, stroke, or communication impairment. A speech therapy referral is not relevant to acute coronary syndrome management
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Rapid replication of stem cells in response to cellular injury.
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Reduced vascular supply to tissues triggering abnormal cell behavior.
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Mutated DNA leading to uncontrolled cellular growth and evasion of apoptosis.
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Cellular fusion leading to abnormal tissue formation.
Explanation
Correct Answer: (C) Mutated DNA leading to uncontrolled cellular growth and evasion of apoptosis.
Malignancy develops when mutations occur in genes that regulate cell growth, division, and death. Proto-oncogenes become oncogenes that drive uncontrolled proliferation, while tumor suppressor genes lose their ability to halt abnormal growth. Cancer cells also evade apoptosis, allowing them to survive and multiply indefinitely.
Why other options are incorrect:
A. Stem cell replication is a normal repair process and does not inherently lead to malignancy unless mutations are involved.
B. Reduced vascular supply causes ischemia and necrosis, not malignant transformation; tumors actually stimulate new blood vessel growth through angiogenesis.
D. Cellular fusion is not the primary mechanism of malignancy development.
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Elevated HDL cholesterol levels
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Elevated LDL cholesterol levels
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Low triglyceride levels
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Decreased total cholesterol levels
Explanation
Correct Answer: (B) Elevated LDL cholesterol levels.
LDL cholesterol is the primary lipid involved in atherosclerosis. Elevated LDL promotes the deposition of lipids into arterial walls, initiating plaque formation that narrows and hardens arteries, significantly increasing the risk of coronary artery disease, stroke, and peripheral vascular disease.
Why the other options are incorrect:
A. Elevated HDL cholesterol is protective against atherosclerosis as it transports cholesterol away from arterial walls back to the liver for excretion.
C. Low triglyceride levels are associated with reduced cardiovascular risk, not increased risk.
D. Decreased total cholesterol levels generally indicate lower cardiovascular risk rather than increased risk for atherosclerosis.
Explanation
Correct Answer: 4.2 mL/hr
Step 1 — Calculate concentration: 50 mg ÷ 250 mL = 0.2 mg/mL = 200 mcg/mL. Step 2 — Convert ordered dose to mL/hr: (14 mcg/min × 60 min/hr) ÷ 200 mcg/mL = 840 ÷ 200 = 4.2 mL/hr.
Explanation
Correct Answer: 30 mL/hr
Formula: Convert weight → Calculate dose → Calculate rate. Step 1 — Convert weight: 314 lb ÷ 2.2 = 142.7 kg. Step 2 — Calculate dose: 142.7 kg × 21 units/kg/hr = 2,996.7 units/hr. Step 3 — Calculate concentration: 25,000 units ÷ 250 mL = 100 units/mL. Step 4 — Calculate rate: 2,996.7 units/hr ÷ 100 units/mL = 29.97 mL/hr ≈ 30 mL/hr.
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