RN ATI Medsurg preassessment questions PDF

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ATI Medsurg Pre-Assessment Questions

RN ATI Capstone Content Review: Medical-Surgical Pre-Assessment Assignment Directions: Please copy and paste the questions below into a document to insert your answers. When you finish, please copy and paste the questions and your answers into a message to me using the classroom message system.

This assignment will assist you in reviewing some of the med-surg topics and strengthen your overall knowledge base before you take the Medical-Surgical Assessment. Please send me your answers so that I can provide you with any needed feedback BEFORE you take your Medical-Surgical Assessment. PLEASE DO NOT copy/paste your answers from the ATI review module/your textbooks/other sources. Reading the content and putting it into your own words is KEY to understanding and increasing your overall knowledge base. The ATI review books are 'review books' they are meant to be a refresher, resource, and supplement to your nursing education - feel free to use your school textbooks for additional information when reviewing and completing assignments as well.

1. What are the manifestations of hypokalemia? Hyperkalemia? Hypokalemia 

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Muscle weakness, cramping Fatigue Nausea Vomiting Irritability Confusion Decreased bowel motility Paresthesia Dysrhythmias Flat and/or inverted T waves (ECG)

Hyperkalemia

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Peaked T-waves (ECG) Ventricular dysrhythmias Muscle Twitching (early) Paresthesia (early Ascending muscle weakness (late) Increased bowel motility

2. What is diabetes insipidus (DI)? What happens with the Na level and the total body water with DI? How is DI treated? Diabetes Insipidus:   

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A deficiency of the antidiuretic hormone (ADH or vasopressin) due to a disorder of the posterior pituitary gland that results in the inability of the kidneys to conserve water appropriately. D.I. is caused by head trauma, tumor, surgery, radiation, CNS infections, malignant tumors, or failure of the renal tubules. The underlying cause of DI

ATI Medsurg Pre-Assessment Questions should be identified and treated. Na level and total body of water during DI:   

» Decreased urine specific gravity » Decreased urine osmolality » Hypernatremia » Increased serum osmolality

3. What are the expected abnormal lab values associated with the following endocrine disorders: Diabetes mellitus, Cushing’s disease, Addison’s disease, and hypothyroidism? Endocrine Disorder Diabetes Mellitus

Expected Abnormal Lab Value  Decreased urine specific gravity  Decreased urine osmolality  Hypernatremia  Increased Serum Osmolality Increased urine output Hemoconcentration

Cushing’s disease

 Hyperglycemia  Hypernatremia  Hypokalemia Hypocalcemia  Elevated triglycerides  Immunosuppression (look at CBC’s and WBC’s)  Increased plasma cortisol levels

Addison’s disease

 Hypotension  Hypoglycemia  Hyponatremia  Hyperkalemia  Hypercalcemia  altered mental health (depression, lability)

Hypothyroidism

Hyperlipidemia Anemia  Low serum T4 and T3  Elevated TSH

ATI Medsurg Pre-Assessment Questions

4. A client is in acute renal failure (ARF). What should the nurse anticipate the client’s creatinine, BUN and potassium levels to be? Acute Renal Failure Creatinine

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Elevated -

BUN

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Elevated -

Potassium

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Elevated-

5. What education should be provided to the client following hemodialysis?  Maintain fluid restrictions

Hemodialysis Patient Education

 No BP readings or blood work on the arm that has the dialysis fistula  Notify nurse of muscle cramps, headache, nausea, or dizziness that occurs during the procedure  Participate in activities to stay pre-occupied during the session (read books, magazines, listen to music, play games, watch tv, have discussions with a nurse or someone nearby if possible) Get weighed before and after the procedure  Monitor the fistula site for clotting and infection  Maintain adequate nutrition Expect that blood pressure will continuously be monitored throughout the dialysis procedure

6. What are assessment findings consistent with a diagnosis of DKA? What are priority interventions for clients with this condition? DKA (Diabetic Ketoacidosis) Assessment findings 

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Exacerbated polyuria, polydipsia, polyphagia Anorexia, nausea, vomiting, abdominal pain Metabolic acidosis with ketonuria Kussmaul’s respirations Acetone breath (fruity breath) Altered mental status, blurred vision, headache Weak, rapid pulse Orthostatic hypotension

Priority Interventions 

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Monitor blood glucose, LOC, vital signs, and strict I & O Administer prescribed IV fluids to promote perfusion Administer insulin Monitor potassium levels & replace as prescribed Monitor acid-base balance Teach strategies to prevent DKA and hyperglycemic hyperosmolar

ATI Medsurg Pre-Assessment Questions state (HHS)

7. What are two potential complications of amputation and nursing interventions for client’s experiencing these complications? Amputation Complications 

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Hemorrhage Infection Phantom limb pain Flexion contractures

Nursing Interventions 

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Assess neurovascular status, psychosocial status, client’s willingness and motivation to withstand prolonged rehabilitation Manage phantom limb and residual limb pain Monitor for signs of wound healing Monitor for complications Promote mobility and range of motion Promote independence Maintain aseptic technique with dressing changes Wrap residual limb with figure-8 elastic bandage after surgical dressing is removed

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8. What are the warning signs of a Myocardial Infarction (MI)? Warning Signs of Myocardial Infarction 

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Severe chest pain Unrelieved with nitroglycerin or rest Crushing equality, radiates to jawline, left arms, neck, and/or back Women, older adults, and clients who have diabetes mellitus often report no pain Diaphoresis, nausea, vomiting, anxiety, fear Vital sign changes: tachycardia, hypotension, dyspnea, dysrhythmias

9. What could go wrong during a blood transfusion? What should the nurse do if a transfusion reaction is suspected? Blood Transfusions What could go wrong? 

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Acute hemolytic reaction Febrile reaction Anaphylactic shock Mild Allergic reaction Hypervolemia Sepsis

Nursing intervention for transfusion reaction: 

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Stop blood infusion immediately and take vital signs Infuse 0.9% sodium chloride Notify provider Follow facility policy (send urine sample, CBC, and bag

ATI Medsurg Pre-Assessment Questions and tubing to lab for analysis)

10. What are some nursing interventions that can decrease intracranial pressure (ICP)? What can cause an increase in ICP (so that the nurse can anticipate the potential increases and respond appropriately)? Intracranial Pressure Causes of increased ICP 

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Head injury with subdural or epidural hematoma Cerebrovascular accident or cerebral edema Brain tumor Hydrocephalus Ruptured aneurysm and subarachnoid hemorrhage Meningitis, encephalitis

Nursing Interventions 

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Monitor vital signs and neurological function Keep head of bed elevated 30 to 45 Keep client’s head in a neutral position to enhance drainage Avoid coughing, sneezing, straining, and suctioning Maintain maximum respiratory exchange Administer oxygen to increase the supply to the brain Monitor fluid I&O. May restrict fluids to prevent increased cerebral edema Administer medications as prescribed Use hypothermia as prescribed to decrease ICP Decrease environmental stimuli Intensive care is required when monitoring ICP (ventriculostomy)

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11. What are the diagnostic criteria for AIDS? Diagnostic Criteria for AIDS -

ELISA (antibody assay) : Positive within 3 weeks to 3 months following infection. Most common and least expensive

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Western Blot blood test (used when ELISA is positive to confirm or rule out infection).

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Plasma HIV-1 RNA viral load is greater than 1,500 copies

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CD4+T cell count: Decreased less than 750 cells/mm3 . Clients with values < 200 cells/mm3 have an 85% likelihood of progressing to AIDS within 3 years. CBC and platelets are decreased Brain, lung, or CT scans may be abnormal

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12. What are the types of viral hepatitis and how are these transmitted?

ATI Medsurg Pre-Assessment Questions Viral Hepatitis Type A (HAV) 

Fecal-oral route, person-to-person, food/water contamination

Type B ( HBV) 

Unprotected sex, sharing needles, needlesticks, blood products; organ transplants before 1992)

Type C (HCV) 

Blood-to-blood, Illicit IV drug sharing, unprotected sex, Blood products; organ transplants before 1992.

13. Explain what the priority care would be for a client who recently had a Transuretheral resection of the prostate (TURP). -

Monitor for shock and hemorrhage Avoid heaving lifting, prolonged sitting, constipation, or straining (can cause rebleed). Monitor for continuous bladder irrigation (expect bloody drainage; monitor I&O’s carefully) Encourage at least 3,000mL fluid daily Assess for TURP Syndrome: hyponatremia, confusion, bradycardia, hypo/hypertension, nausea, vomiting, visual changes Keep pain under control with medication; meds and narcotics may be needed to decrease bladder spasms Keep catheter taped tightly to the leg. Perform kegel exercises (there may be temporary or permanent loss of sexual function or urinary control)

14. A client has a chest tube with continuous bubbling in the water seal chamber. What does this mean and what actions should the nurse take? What actions should the nurse take if the chest tube becomes disconnected from the closed drainage system or pulled out? Chest Tube Signs

Meaning

Nursing Intervention

Continuous bubbling in water seal chamber 

Air leak

» Start at the chest and move down tubing to locate leak » Tighten connection or replace drainage system » Keep connection taped securely

Chest tube becomes disconnected from closed drainage system

Disconnection

» Insert open end of the chest tube into sterile water until system can be replaced

Chest tube gets pulled out

Disconnection

» Cover insertion site w/ sterile dressing, taped on three sides » Contact provider » Prepare for reinsertion

15. Explain the manifestations of pulmonary edema and two possible causes for this condition. Pulmonary Edema

ATI Medsurg Pre-Assessment Questions

Manifestations 

Two possible causes 

Anxiety, feelings of impending doom, pressure in chest, pain upon inspiration and chest wall tenderness, dyspnea and air hunger, cough, hemoptysis Hypercoagulability, heart failure or chronic A. Fib.

16. A client who is having an asthmatic attack enters the ED. Explain the priority actions that should be taken to assist this client. Status Asthmaticus Priority Actions:

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Place in high-fowler’s Prepare for emergency intubation Administer oxygen, epinephrine, and systemic steroid as prescribed Provide emotional support

17. Identify ways the nurse can provide cognitive stimulation for the client with Alzheimer’s disease. Alzheimer’s Disease: Cognitive Stimulation -

Walks, music, craft activities

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Keep a structured environment and introduce change gradually

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Use a calendar to assist with orientation

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Use short directions when explaining an activity or care the client needs, such as a bath

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Be consistent and repetitive

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Use therapeutic touch

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Provide memory training (reminisce about the past, making lists and rehearsing, repeating client’s last statement)

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Avoid overstimulation (noise and clutter to a minimum, avoid crowds)

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Reality orientation with clocks, single-day calendar, pictures of family and pets, frequent orientation to time, place, and person

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Validation therapy

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Promote self-care as long as possible

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Reduce agitation

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Provide a routine toileting schedule

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Speak directly to the client in short, concise sentences

ABGs Interpretation

ATI Medsurg Pre-Assessment Questions 18. ABG Question 1 pH 7.18 PaCO2 38 PaO2 70 HCO3 15 What is this? Metabolic acidosis What could have caused it? Diarrhea, fever, hypoxia, starvation, overdose; salicylates or ethanol, renal failure, DKA, dehydration 19. ABG Question 2 pH 7.60 PaCO2 30 PaO2 60 HCO3 22 What is this? Respiratory alkalosis What could have caused it? Hyperventilation, hypoxemia, altitude sickness, asphyxiation, asthma, pneumonia 20. ABG Question 3 pH 7.58 PaCO2 35 PaO2 75 HCO3 50 What is this? Metabolic alkalosis What could have caused it? Ingestion of antacids, TPN, GI suctions, hypokalemia, blood transfusion, prolonged vomiting...