ATI Custom NUR 2610 Exam 4 Version 1
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Free ATI Custom NUR 2610 Exam 4 Version 1 Questions
A nurse in the emergency department (ED) is caring for a male client.
Nurses' Notes — 3 days ago, 1000: Client admitted to the ED with report of burning pain in the right lower leg and foot when walking no further than 2 blocks. Leg pain is relieved with rest.
Client reports new onset of aching right leg pain at rest that wakes them up at night.
Client reports leg pain increases with elevation and is relieved when leg is placed in a dependent position.
Right calf is shiny, with scant hair present, skin dry, foot color hyperpigmented when in a dependent position and lighter in color when elevated.
- Oxygen saturation
- Appearance of the right foot
- Heart rate
- Potassium level
- Pedal pulses
- Breath sounds
- Blood pressure
Explanation
Correct Answer: (B) Appearance of the right foot, (E) Pedal pulses, (F) Breath sounds
This client's presentation is consistent with peripheral arterial disease (PAD), evidenced by intermittent claudication relieved by rest, rest pain that worsens with elevation and improves in a dependent position, and classic ischemic skin changes. The appearance of the right foot requires follow-up because the notes describe shiny skin, scant hair, dry skin, dependent rubor with pallor on elevation, and a 4.5 mm ulceration on the great toe. Pedal pulses require follow-up because the right pedal pulse is diminished at 1+ compared to the left at 2+, indicating reduced arterial perfusion. Breath sounds require follow-up because the client has scattered rhonchi bilaterally along with a 45-year smoking history, raising concern for an underlying respiratory condition.
Why the other options are incorrect:
A. Oxygen saturation — No abnormal value is documented to indicate a need for follow-up.
C. Heart rate — The apical pulse is documented as regular, with no abnormal rate noted.
D. Potassium level — No potassium value is provided, and nothing points to an electrolyte concern.
G. Blood pressure — No blood pressure value is documented to suggest an abnormality.
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Administer medications to prevent fluid overload.
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Send blood samples to the lab for compatibility testing.
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Remain with the client and monitor for signs of transfusion reaction.
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Increase the infusion rate to the maximum speed allowed by facility policy.
Explanation
Correct Answer: (C) Remain with the client and monitor for signs of transfusion reaction.
The first 15 minutes of a blood transfusion are the most critical period for identifying acute transfusion reactions, including hemolytic reactions, allergic reactions, and anaphylaxis. The nurse must remain at the bedside to detect early signs such as fever, chills, itching, dyspnea, or hypotension and stop the transfusion immediately if a reaction occurs.
Why other options are incorrect:
A. Medications to prevent fluid overload such as furosemide may be prescribed for high-risk clients but are not the priority action during the initial 15 minutes.
B. Compatibility testing is completed before the transfusion begins, not during administration.
D. Blood transfusions are started slowly during the first 15 minutes to allow for early detection of reactions; increasing to maximum speed during this period is unsafe.
What lifestyle change should be prioritized for a client diagnosed with Cushing's Disease?
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Eliminating carbohydrates entirely from the diet.
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Engaging in high-impact physical exercises.
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Increasing calorie consumption to counteract metabolism changes.
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Avoiding salt to reduce fluid retention.
Explanation
Correct Answer: (D) Avoiding salt to reduce fluid retention.
Cushing's Disease results in excess cortisol, which promotes sodium and water retention, leading to hypertension and edema. Prioritizing a low-sodium diet helps manage fluid retention and reduce the risk of associated complications like high blood pressure.
Why the other options are incorrect:
A. Eliminating carbohydrates entirely from the diet — This is an extreme and unnecessary dietary change; while blood glucose monitoring is important due to cortisol's effect on glucose metabolism, complete carbohydrate elimination is not the priority or appropriate approach.
B. Engaging in high-impact physical exercises — Clients with Cushing's Disease often have muscle weakness, bone density loss, and increased fracture risk, making high-impact exercise inappropriate and potentially harmful.
C. Increasing calorie consumption to counteract metabolism changes — Clients with Cushing's Disease typically need to manage weight gain caused by excess cortisol, so increasing calorie intake would worsen this issue rather than help.
A nurse is planning care for several clients and is considering the clients' risk for stroke. Which of the following conditions places the client at risk for an embolic stroke?
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A client who has thrombocytopenia.
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A client who has an arteriovenous malformation.
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A client who has atherosclerosis of the carotid artery.
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A client who has chronic atrial fibrillation.
Explanation
Correct Answer: (D) A client who has chronic atrial fibrillation.
In atrial fibrillation, the atria quiver instead of contracting effectively, causing blood to pool and stagnate. This stasis promotes clot formation within the atria, and a piece of that clot can dislodge, travel through the bloodstream, and lodge in a cerebral vessel, causing an embolic stroke.
Why the other options are incorrect:
A. A client who has thrombocytopenia — Low platelet counts increase the risk of bleeding, not clot formation, making a hemorrhagic event more likely than an embolic stroke. B. A client who has an arteriovenous malformation — This is a structural vascular abnormality that increases the risk of a hemorrhagic stroke due to vessel rupture, not embolism. C. A client who has atherosclerosis of the carotid artery — This increases the risk of a thrombotic stroke, where plaque buildup narrows the vessel and a clot forms locally, rather than an embolus traveling from elsewhere.
5 mm (0.2 in) ulceration noted on end of right great toe.
Left pedal pulses palpable at 2+
Right pedal pulses palpable at 1+
Client is alert and oriented to person, place, and time.
Bilateral breath sounds with scattered rhonchi throughout. Apical pulse is regular. Client reports a 45-year smoking history.
For each client's finding, specify if the assessment finding is consistent with chronic venous insufficiency/peripheral venous disease and/or peripheral arterial disease. Each finding might support more than one disease process.
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Skin on the right leg
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BMI
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Serum lipid values
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Pedal pulses
Explanation
Correct Answer:
A. Skin on the right leg — Peripheral arterial disease; B. BMI — Chronic venous insufficiency/Peripheral venous disease AND Peripheral arterial disease; C. Serum lipid values — Peripheral arterial disease; D. Pedal pulses — Peripheral arterial disease
The client's shiny, thin, hairless, dry skin with dependent rubor and an ulceration at the tip of the toe are classic findings of arterial insufficiency, not venous disease, since venous ulcers typically occur near the medial malleolus with surrounding hemosiderin staining and edema, a pattern not described here. Elevated BMI/obesity is a shared risk factor for both disease processes, since excess weight impairs venous return through increased pressure on leg veins and also contributes to atherosclerosis affecting the arteries. Elevated serum lipid values directly promote atherosclerotic plaque formation, driving peripheral arterial disease rather than venous insufficiency. Diminished pedal pulses (right at 1+ versus left at 2+) reflect impaired arterial blood flow, a hallmark of peripheral arterial disease, since venous insufficiency does not typically affect pulse quality.
Why the findings don't map elsewhere:
Skin on the right leg is not marked under venous insufficiency because the description of shiny, hairless skin with dependent rubor and a distal toe ulcer does not match the stasis dermatitis, hemosiderin staining, or medial ankle ulceration typical of venous disease. Serum lipid values are not marked under venous insufficiency because lipid abnormalities are linked to atherosclerotic arterial narrowing, not venous valve dysfunction. Pedal pulses are not marked under venous insufficiency because venous disease does not impair arterial pulse strength.
A nurse caring for a client who has hypertension asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is contraindicated in clients who have a history of which of the following conditions?
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Depression
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Asthma and COPD
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Migraines
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Glaucoma
Explanation
Propranolol is a nonselective beta-blocker, meaning it blocks both beta-1 and beta-2 receptors. Blocking beta-2 receptors in the lungs causes bronchoconstriction, which can trigger severe bronchospasm in clients with asthma or COPD, making it contraindicated in these clients.
Why the other options are incorrect:
A. Depression — While beta-blockers can occasionally worsen mood symptoms, this is not the primary contraindication associated with propranolol. C. Migraines — Propranolol is actually used therapeutically to help prevent migraines, so this is not a contraindication. D. Glaucoma — Beta-blockers, including propranolol, are not contraindicated in glaucoma; in fact, topical beta-blockers are used to treat glaucoma by reducing intraocular pressure.
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Pulmonary embolism
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Improved gas exchange
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Increased elastin production
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Air trapping and hyperinflation
Explanation
Correct Answer: (D) Air trapping and hyperinflation. In COPD, loss of elastic recoil and destruction of alveolar walls cause the small airways to collapse during exhalation, trapping air within the alveoli. This air trapping leads to hyperinflation of the lungs, which limits airflow and reduces the space available for effective gas exchange during subsequent breaths.
Why the other options are incorrect:
A. Pulmonary embolism — This is a vascular obstruction caused by a blood clot, not a structural airway change associated with COPD's airflow limitation. B. Improved gas exchange — COPD causes impaired, not improved, gas exchange due to alveolar destruction and airflow limitation. C. Increased elastin production — COPD is actually characterized by the breakdown and loss of elastin in lung tissue, not increased production, which contributes to the loss of elastic recoil.
A nurse is teaching a patient with chronic pancreatitis who has a prescription for pancreatic enzymes three times per day. Which of the following statements indicates understanding of the teaching?
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"I will take the enzymes to help digest fat in foods."
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"I will take the enzymes 2 hours before meals."
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"I will take the enzymes following meals."
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"I will take the enzymes to improve my metabolism."
Explanation
Correct Answer: (A) "I will take the enzymes to help digest fat in foods."
Pancreatic enzyme replacements contain lipase, protease, and amylase, which assist in the digestion of fats, proteins, and carbohydrates. In chronic pancreatitis, the pancreas often cannot produce enough of these enzymes on its own, leading to fat malabsorption and steatorrhea, so understanding that the enzymes aid fat digestion reflects correct comprehension of their purpose.
Why Other Options are Incorrect:
B. "I will take the enzymes 2 hours before meals." — Pancreatic enzymes should be taken with meals or snacks, not hours in advance, so they are available in the gut at the same time as the food being digested. C. "I will take the enzymes following meals." — Taking enzymes after meals is incorrect timing, as they need to be present in the digestive tract during food intake to be effective. D. "I will take the enzymes to improve my metabolism." — Pancreatic enzymes assist with digestion, not metabolism, so this statement reflects a misunderstanding of their purpose.
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Hairless lower legs.
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Hyperpigmentation in the lower extremities.
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Bounding pedal pulses.
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Pallor on leg elevation.
Explanation
Correct Answer: (B) Hyperpigmentation in the lower extremities.
Chronic venous insufficiency causes prolonged venous stasis, leading to red blood cell extravasation into surrounding tissues. Hemosiderin deposits from the breakdown of these cells cause the characteristic brownish hyperpigmentation seen in the lower legs, particularly around the ankles.
Why the other options are incorrect:
A. Hairless lower legs is a classic sign of peripheral arterial disease (PAD), not venous insufficiency, due to poor arterial perfusion affecting hair follicles.
C. Bounding pedal pulses indicate adequate arterial flow and are not a sign of venous insufficiency.
D. Pallor on leg elevation is a sign of PAD, reflecting inadequate arterial perfusion when the limb is raised against gravity.
Vital Signs — 1500: Temperature 37.3° C (99.1° F) BP 154/64 mm Hg Heart rate 105/min Respiratory rate 26/min Oxygen saturation 93% on room air
Medical History: Cirrhosis Hypertension, controlled with metoprolol therapy Type 2 diabetes mellitus, controlled with glipizide therapy
Physical Examination — 1500: Client presents with decreased level of consciousness, slurred speech, and impaired concentration. Client is lethargic, does not respond to questions or simple commands. Pupils round, reactive to light and accommodation. Partner states client has been sleeping during the day and remains awake at night.
Skin is dry and jaundiced with petechiae present to arms and legs.
S1 S2 heard on auscultation. +1 pulses on bilateral radial and pedal pulses. Peripheral edema +3 present in bilateral lower extremities.
Crackles auscultated in bilateral lower lobes.
Abdomen distended with ascites. Hypoactive bowel sounds present in all four quadrants. Partner reports no knowledge of rectal bleeding, states client has been tolerating diet with no nausea or vomiting.
Client placed in semi-Fowler's position at 45°, feet elevated. Bed in low position. Partner remains at client's bedside.
Liver disease complication. Drag 1 condition and 1 client finding to fill in each blank in the following sentence.
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