ATI RN Adult Medical Surgical Exam

Correct Answer B: 30 mL/hr

Explanation of the Correct Answer:

The ordered dose is 2 mg/min.

Convert this to mg/hr:

2 mg/min × 60 min/hr = 120 mg/hr

Now use the concentration:

400 mg in 100 mL = 4 mg/mL

Now calculate the mL/hr:

120 mg/hr ÷ 4 mg/mL = 30 mL/hr

Why the Other Options Are Incorrect:

A. 15 mL/hr

Delivers only 60 mg/hr, which is half the prescribed dose. This would result in underdosing.

C. 25 mL/hr

Delivers 100 mg/hr (25 mL × 4 mg/mL), which is less than the prescribed 120 mg/hr.

D. 30 mL/hr

This is the correct dose as it delivers the required 120 mg/hr (30 mL × 4 mg/mL).

Correct Answer:

Hyponatremia.

Explanation:

Clients with a nasogastric (NG) tube, particularly those undergoing gastric suctioning, are at increased risk of electrolyte imbalances, with hyponatremia being a primary concern. Gastric secretions contain significant amounts of sodium, and when large volumes of gastric contents are removed, sodium can be lost. Additionally, clients may be receiving hypotonic fluids or have reduced oral intake, which further exacerbates the risk of hyponatremia. Symptoms of hyponatremia can include confusion, weakness, headaches, and even seizures. Therefore, regular monitoring of sodium levels is crucial in these patients to prevent serious complications related to this electrolyte imbalance.

Why Other Options Are Wrong:

Metabolic acidosis

This is incorrect because NG tube suctioning typically leads to metabolic alkalosis, not acidosis. The loss of hydrochloric acid from the stomach during suctioning can raise the body’s pH, making it more alkaline. Metabolic acidosis is more often seen with conditions such as diarrhea, diabetic ketoacidosis (DKA), or renal failure, not as a result of NG suctioning.

Constipation

This is incorrect because constipation is not a common issue associated with NG tubes. In fact, patients with NG tubes, especially those receiving tube feedings, are more likely to experience diarrhea due to the effects of the feedings or medications. While decreased mobility and certain medications can contribute to constipation, electrolyte imbalances like hyponatremia pose a more immediate concern.

Fluid overload

This is incorrect because clients with NG tubes are generally more prone to fluid volume deficit, not overload. Continuous gastric drainage, along with potentially decreased oral intake and vomiting, increases the risk of dehydration. Fluid overload is less common in this situation, and careful fluid replacement is needed to prevent dehydration rather than excessive fluid retention.

Correct Answer:

Palpate the dorsalis pedis pulse

Explanation:

Following the application of an external fixator, the nurse's priority action is to assess the neurovascular status of the affected extremity. One of the best ways to do this is by palpating the dorsalis pedis pulse, which allows the nurse to assess circulation to the foot. A palpable dorsalis pedis pulse indicates that blood flow is adequate, helping to prevent complications like compartment syndrome, which can lead to irreversible tissue damage. This pulse check, along with assessments of skin color, temperature, capillary refill, sensation, and movement, provides a comprehensive evaluation of the limb's status after surgery.

Why Other Options Are Wrong:

Maintain the affected extremity in a dependent position

This is incorrect because maintaining the extremity in a dependent position (hanging down) increases the risk of swelling (edema) and can compromise circulation. The affected limb should be elevated to promote venous return, reduce swelling, and enhance the healing process. Keeping the extremity elevated also helps prevent complications such as increased pressure on the surgical site or further compromise of blood flow.

Wrap sterile gauze on the sharp point of the pins

This is incorrect because while it is important to care for the external fixator pin sites to prevent infection, wrapping sterile gauze around the sharp points of the pins is not recommended. This can trap moisture and debris, increasing the risk of infection at the pin sites. The proper technique involves cleaning the pin sites according to hospital protocol and ensuring they remain dry and free of contaminants.

Adjust the clamps on the fixator frame

This is incorrect because adjusting the external fixator clamps is outside the nurse's scope of practice. Only the provider or trained orthopedic specialist should adjust the fixator frame. Improper adjustment could destabilize the fixation, compromise the healing process, or cause harm to the patient. The nurse's role is to monitor for complications and provide appropriate care without altering the device itself.

Correct Answer:

Stridor

Explanation:

Stridor is a high-pitched, harsh, crowing sound that indicates upper airway obstruction, often caused by laryngeal edema or laryngospasm following extubation. This sound is a medical emergency because it signifies that the airway may be compromised, and if untreated, it could progress to complete airway obstruction. In such cases, the nurse must take immediate action, including notifying the provider, preparing for possible reintubation, and administering treatments like humidified oxygen or nebulized racemic epinephrine or corticosteroids to reduce swelling in the airway. Maintaining a patent airway is paramount, and stridor is the clearest sign that urgent intervention is necessary to prevent respiratory failure.

Why Other Options Are Wrong:

Rhonchi

Rhonchi refers to low-pitched, coarse lung sounds that are typically associated with mucus or secretions in the larger airways. While rhonchi indicates the need for intervention such as suctioning or encouraging coughing, it does not represent an immediate, life-threatening situation like stridor. Rhonchi is not a sign of upper airway obstruction and can often be managed with non-emergency measures.

Sore throat

A sore throat is a common, expected occurrence following extubation, typically caused by irritation from the endotracheal tube. It is not an emergency, and it generally resolves on its own or with supportive care such as throat lozenges or warm fluids. Unlike stridor, a sore throat does not pose a risk to airway patency and does not require immediate intervention.

SaO2 92%

An oxygen saturation of 92% is generally acceptable in most post-extubation situations, especially if the patient is stable and not showing signs of further deterioration. Although it is slightly below the normal range of 95–100%, it does not warrant immediate action unless it begins to drop further or is accompanied by signs of respiratory distress. In the absence of additional symptoms, SaO2 at 92% is not a critical finding that requires urgent intervention.

Correct Answer B: Ibuprofen

Explanation of the Correct Answer:

Ibuprofen, like naproxen, is a nonsteroidal anti-inflammatory drug (NSAID). Taking two NSAIDs concurrently increases the risk of gastrointestinal bleeding, ulcers, and renal impairment. NSAIDs inhibit prostaglandin synthesis and reduce the protective lining of the stomach, which heightens the chance of bleeding, especially with chronic use.

Why the Other Options Are Incorrect:

A. Digoxin

Digoxin is used to treat heart failure and atrial fibrillation. It does not have anticoagulant or antiplatelet effects and does not increase the risk of bleeding when taken with naproxen.

C. Captopril

Captopril is an ACE inhibitor used for hypertension and heart failure. While it can affect renal function, it does not directly increase bleeding risk when combined with NSAIDs.

D. Phenytoin

Phenytoin is an anticonvulsant. It can affect liver enzyme activity and drug metabolism but does not significantly increase the risk of bleeding when taken with naproxen.

Correct Answer D: Wear a lead apron when providing client care.

Explanation of the Correct Answer:

When caring for a client undergoing internal radiation therapy (brachytherapy), the nurse should wear a lead apron to minimize radiation exposure. Lead aprons provide essential shielding from the radiation source, especially when close physical contact with the client is required. Radiation exposure should always be minimized by following time, distance, and shielding protocols, with shielding—such as a lead apron—being a primary method for protection.

Why the Other Options Are Incorrect:

A. Place a dosimeter on the client's gown.

A dosimeter is a radiation detection device worn by healthcare workers to monitor their own exposure to radiation—not by the client. It should be worn by staff providing care to ensure they stay within safe exposure limits.

B. Ensure the door to the client's room remains open.

The door to the client's room should remain closed to contain radiation and protect others in the surrounding area. Proper signage should also be posted to indicate that radiation therapy is in use.

C. Wear sterile gloves during patient care.

Sterile gloves are not required unless performing a sterile procedure. Standard precautions apply, and radiation protection is the priority—not sterility—unless clinically indicated. Regular clean gloves are typically sufficient.

Correct Answer A: Small blisters on the skin

Explanation of the Correct Answer:

Small blisters on the skin are a sign of phototoxic reaction or overexposure to ultraviolet (UV) light during phototherapy. This reaction is similar to a sunburn and can cause erythema, tenderness, and blistering. Overexposure increases the risk of skin damage and long-term complications such as premature aging or skin cancer.

Why the Other Options Are Incorrect:

B. Increased joint pain

Psoriasis can be associated with psoriatic arthritis, but joint pain is not a direct effect or indicator of overexposure during phototherapy.

C. Cool, moist extremities

This finding may be associated with shock or circulatory problems, but it is not related to phototherapy overexposure.

D. Increased body temperature

While overheating can occur with prolonged light exposure, fever is not a typical or specific indicator of phototherapy overexposure. Blistering and skin reactions are more accurate signs.

Correct Answer:

Supine with the head slightly elevated

Explanation:

After a total hip arthroplasty (hip replacement), the priority is to prevent hip dislocation. The safest position is supine with the head slightly elevated (around 30 degrees), which helps maintain the proper alignment of the hip. In this position, an abduction pillow or pillows placed between the legs prevent adduction (bringing the legs together) and internal rotation, movements that increase the risk of dislocation. By maintaining this position, the hip joint remains stable and is less likely to dislocate during the early postoperative period.

Why Other Options Are Wrong:

Side-lying on the affected side

This is incorrect because lying on the surgical side (affected side) puts direct pressure on the healing joint, increasing the risk of dislocation and discomfort. Early after surgery, it is important to avoid putting weight on the operated hip. If side-lying is allowed later, it would be on the unaffected side, with pillows between the knees to prevent adduction, not on the affected side.

High-Fowler's with a pillow under the knees

This is incorrect because the High-Fowler's position (with the head raised more than 60 degrees) increases hip flexion, which stresses the new hip joint and raises the risk of dislocation. Furthermore, placing a pillow under the knees causes knee flexion, which can impair circulation and increase the risk of complications such as deep vein thrombosis (DVT). This position is not recommended postoperatively.

Prone with the legs adducted

This is incorrect because prone positioning (lying on the stomach) is generally avoided after hip surgery due to discomfort and the potential for twisting of the hip. Additionally, adduction, or bringing the legs together, is a movement that should be avoided as it increases the risk of hip dislocation. Adduction compromises the safe healing alignment of the hip joint, making this position unsafe for patients recovering from hip replacement surgery.

Correct Answer:

Adjust the dial until you feel a pins-and-needles sensation.

Explanation:

A transcutaneous electrical nerve stimulation (TENS) unit functions by sending low-voltage electrical impulses through electrodes placed on the skin. These impulses are designed to disrupt pain signals traveling to the brain and stimulate the release of endorphins, the body’s natural pain relievers. The correct client education involves adjusting the intensity dial to a level where the client feels a mild tingling or "pins-and-needles" sensation. This indicates the unit is properly engaged and effectively stimulating the nerves. The sensation should not be painful or cause muscle contractions. Clients are encouraged to find a comfortable setting that provides relief without discomfort, and this is best done by adjusting the unit to this characteristic tingling sensation.

Why Other Options Are Wrong:

"This device delivers heat via electrodes that are attached to the affected area."

This is incorrect because TENS units do not deliver heat. Their mechanism of action is purely electrical stimulation of nerves. Heat-based pain relief devices, such as heating pads or infrared lamps, are separate modalities and function differently. Providing this incorrect information may cause the client to misuse the device or have improper expectations about its effect.

"This device requires access to a 220-volt outlet."

This is incorrect. TENS units are usually battery-operated or compatible with standard 110-volt household electrical outlets, especially in the U.S. They are designed for portable, convenient, and at-home use, and they do not require high-voltage power sources. Instructing the client otherwise may lead to confusion and unnecessary concern about device setup.

"You can apply the electrodes directly over sensitive areas of skin."

This is incorrect because electrodes should not be applied over broken, irritated, numb, or highly sensitive skin. Doing so increases the risk of skin damage or irritation and may reduce the effectiveness of the treatment. The correct practice is to apply electrodes to clean, dry, intact skin near the site of pain, following manufacturer guidelines and any healthcare provider instructions.

In summary, instructing the client to adjust the dial until they feel a tingling sensation ensures they use the TENS unit correctly and safely. The other options reflect misunderstandings about the function, power requirements, and safe use of the device.