MED SURGE GI ACTUAL EXAM WITH 100+ QUESTIONS AND CORRECT ANSWERS WITH RATIONALES (100% CORRECT ANSWERS) ACTUAL ATI MED SURGE GI (GASTROINTESTINAL) EXAM GRADED A+(MOST RECENT!!)
What instruction should the nurse include in the discharge teaching plan of a client who had a cataract extraction today? - ANSWER Light housekeeping is permitted but avoid heavy lifting
A male adult comes to the urgent care clinic 5 days after being diagnose with influenza. He is short of breath, febrile, and coughing green colored sputum. Which intervention should the nurse implement first? - ANSWER Obtain a sputum sample
for culture
An elder male client tells the nurse that he is loosing sleep because he has to get up several times at night to go to the bathroom that he has trouble starting his urinary stream and that he does not feel like his bladder is ever completely empty. Which intervention should the nurse implement? - ANSWER palpate the bladder above the symphysis pubis
An adult client is admitted with diabetic ketoacidosis (DKA) and a urinary tract infection (UTI) Prescriptions for intravenous antibiotics and insulin infusion are initiated. Which serum laboratory value warrants the most immediate intervention by the nurse? - ANSWER potassium of 2.5 meq/l
A client with sickle cell anemia develops a fever during the last hour of administration
of a unit of packed red blood cell. When notifying the healthcare provider what information should the nurse provide first using the SBAR communication process? -
ANSWER explain specific reason for urgent notification
An adult male client is admitted for pneumocystis carinil pneumonia (PCP) secondary to aids. While hospitalize he receives IV pentamidine isethionate therapy. In preparing this client for discharge what important aspect regarding his medication therapy should the nurse explain? - ANSWER It will be necessary to continue prophylactic doses of IV or aerosol pentamine every month
A client subjective data includes dysuria, urgency, and urinary frequency. What action should the nurse implement next? - ANSWER collect a clean catch specimen A client tells the nurse that her biopsy results indicate that the cancer cells are well differentiated How should the nurse respond? - ANSWER ask the client in the healthcare provider has giving her any information about the classification of her cancer
A client with a chronic kidney disease is treated on hemodialysis. During the 1 treatment clients blood pressure drops from 150/90 to 80/30 Which action should the
nurse take first? - ANSWER stop dialysis treatment
A client with deep vain thrombosis (DVT) is receiving a continues infusion of heparin sodium 25,000 unit in 5% dextrose injection 250ml. The prescription indicates the dosage should be increase 900 units/hr. The nurse should program the infusion pump to deliver how many ml/hr? - ANSWER 9
The nurse is obtaining the admission history for a client with suspected peptic ulcer disease (PUD). Which subjective data reported by the client supports this diagnosis?
- ANSWER upper mid abdominal gnawing and burning pain
The nurse is providing preoperative education for a jewish client schedule to receive a xenograft graft to promote burn healing. Which information should the nurse provide this client? - ANSWER the xenograft is taken from nonhuman sources
A client who took a camping vacation two weeks ago in a country with a tropical climate comes to the clinic describing vague symptoms and diarrhea for the past week. Which finding is most important for the nurse to report? - ANSWER jaundice
sclera
During a home visit the nurse assesses the skin of a client with eczema who reports than an exacerbation of symptoms has occurred during the last week. Which information is most useful in determining the possible cause of the symptoms? - ANSWER a grandson and his new dog recently visited
When explaining dietary guidelines to a client with acute glomerulonephritis (AGN) which instruction should the nurse include in the dietary teaching - ANSWER restrict sodium intake
A male client who is 24hr post operative for an exploratory laparoctomy complains that he is starving because he has had no real food since before surgery. Prior to advancing his diet which intervention should the nurse implememt? - ANSWER Auscultate bowel sound in all four quadrants
A client diagnose with stable angina secondary to ischemic heart disease has a prescription for sublingual (SL) nitroglycerin (NTG). The nurse should tell the client to
follow which instructions if chest pain is not relieved after taking 3 NTG tables 5 min apart - ANSWER call 911 pain is unrelieved and chew a tablet of aspirin 325mg
After taking orlistat (Xenical) for one week a femela client tells the home health nurse
that she is experiencing increasingly frequent oily stools and flatus. What action should the nurse take? - ANSWER ask the client to describe her dietary intake history for the last several days Two days after an abscess of the chin was drained the client returns to the clinic with
fever chills and a maculopapular rash with pruritis. The client has taken an oral antibiotic and cleansed the wound today with provide iodine (Betadine) solution. Which intervention should the nurse implement first? - ANSWER assess airway patency and oxygen saturation
A client experiences an ABO incompatibility reaction after multiple blood transfusions. Which finding should the nurse report immediately to the health care provider? - ANSWER low back pain and hypotension
1.A young adult male who has had type 2 diabetes mellitus (DM) is admitted to the intensive care unit with hyperglycemic nonketotic syndrome (HHNS). A sliding scale protocol for an isotonic IV solution with regular insulin is prescribed based on the results of a continuous blood glucose monitoring device that is attached to the client's central venous catheter. When the client's respirations become labored and his lungs sound indicate crackles what action should the nurse take? - ANSWER decrease infusion rate to address fluid overload
When preparing to apply a fentanyl (Duragesic) transdermal patch the nurse notes that the previously applied patch is intact on the client's upper back and the client denies pain. What action should the nurse take? - ANSWER Apply a new patch in a different location after removing the original patch
A client who had a myocardial infarction is admitted to the coronary critical care unit (CCU) with a nitroglycerin drip infusing. The clients last blood pressure measurements was 78/36.What action should the nurse implement? - ANSWER reduce the rate of the nitroglycerin infusion
An adolescent is admitted to the hospital because of a suicide attempt with an overdose of acetaminophen (Tylenol). Which blood values are most important for the
nurse to monitor during the first 72 hours following ingestion of this overdose? - ANSWER LDH OR LD, SGOT OR ALT, SGPT OR AST
An elderly post-operative female client is receiving morphine sulfate via a PCA pump. Which assessment finding should prompt a nurse to administer the prescribed
PRN medication naloxone? - ANSWER her respiratory rate is 7 breath/minute
Which assessment finding indicates to the nurse that the muscarinic agent bethanechol (Urecholine) is effective for a client diagnose with urinary retention? - ANSWER urinary output equal to intake
Following involvement in a motor vehicle collision, a middle aged adult client is admitted to the hospital with multiple facial fractures. The client's blood alcohol level is high on admission. Which PRN prescription should be administer if the clients begins to exhibit signs and symptoms of delirium tremens (DT s)? - ANSWER Lorazepam (Ativan) 2mg IM
What instruction should the nurse include in the discharge teaching plan of a client who had a cataract extraction today? - ANSWER Light housekeeping is permitted but avoid heavy lifting
A male adult comes to the urgent care clinic 5 days after being diagnose with influenza. He is short of breath, febrile, and coughing green colored sputum. Which intervention should the nurse implement first? - ANSWER Obtain a sputum sample
for culture
An elder male client tells the nurse that he is loosing sleep because he has to get up several times at night to go to the bathroom that he has trouble starting his urinary stream and that he does not feel like his bladder is ever completely empty. Which intervention should the nurse implement? - ANSWER palpate the bladder above the symphysis pubis
An adult client is admitted with diabetic ketoacidosis (DKA) and a urinary tract infection (UTI) Prescriptions for intravenous antibiotics and insulin infusion are initiated. Which serum laboratory value warrants the most immediate intervention by the nurse? - ANSWER potassium of 2.5 meq/l
A client with sickle cell anemia develops a fever during the last hour of administration
of a unit of packed red blood cell. When notifying the healthcare provider what information should the nurse provide first using the SBAR communication process? -
ANSWER explain specific reason for urgent notification
An adult male client is admitted for pneumocystis carinil pneumonia (PCP) secondary to aids. While hospitalize he receives IV pentamidine isethionate therapy. In preparing this client for discharge what important aspect regarding his medication therapy should the nurse explain? - ANSWER It will be necessary to continue prophylactic doses of IV or aerosol pentamine every month
A client subjective data includes dysuria, urgency, and urinary frequency. What action should the nurse implement next? - ANSWER collect a clean catch specimen A client tells the nurse that her biopsy results indicate that the cancer cells are well differentiated How should the nurse respond? - ANSWER ask the client in the healthcare provider has giving her any information about the classification of her cancer
A client with a chronic kidney disease is treated on hemodialysis. During the 1 treatment clients blood pressure drops from 150/90 to 80/30 Which action should the
nurse take first? - ANSWER stop dialysis treatment
A client with deep vain thrombosis (DVT) is receiving a continues infusion of heparin sodium 25,000 unit in 5% dextrose injection 250ml. The prescription indicates the dosage should be increase 900 units/hr. The nurse should program the infusion pump to deliver how many ml/hr? - ANSWER 9
The nurse is obtaining the admission history for a client with suspected peptic ulcer disease (PUD). Which subjective data reported by the client supports this diagnosis?
- ANSWER upper mid abdominal gnawing and burning pain
The nurse is providing preoperative education for a jewish client schedule to receive a xenograft graft to promote burn healing. Which information should the nurse provide this client? - ANSWER the xenograft is taken from nonhuman sources
A client who took a camping vacation two weeks ago in a country with a tropical climate comes to the clinic describing vague symptoms and diarrhea for the past week. Which finding is most important for the nurse to report? - ANSWER jaundice
sclera
During a home visit the nurse assesses the skin of a client with eczema who reports than an exacerbation of symptoms has occurred during the last week. Which information is most useful in determining the possible cause of the symptoms? - ANSWER a grandson and his new dog recently visited
When explaining dietary guidelines to a client with acute glomerulonephritis (AGN) which instruction should the nurse include in the dietary teaching - ANSWER restrict sodium intake
A male client who is 24hr post operative for an exploratory laparoctomy complains that he is starving because he has had no real food since before surgery. Prior to advancing his diet which intervention should the nurse implememt? - ANSWER Auscultate bowel sound in all four quadrants
A client diagnose with stable angina secondary to ischemic heart disease has a prescription for sublingual (SL) nitroglycerin (NTG). The nurse should tell the client to
follow which instructions if chest pain is not relieved after taking 3 NTG tables 5 min apart - ANSWER call 911 pain is unrelieved and chew a tablet of aspirin 325mg
After taking orlistat (Xenical) for one week a femela client tells the home health nurse
that she is experiencing increasingly frequent oily stools and flatus. What action should the nurse take? - ANSWER ask the client to describe her dietary intake history for the last several days Two days after an abscess of the chin was drained the client returns to the clinic with
fever chills and a maculopapular rash with pruritis. The client has taken an oral antibiotic and cleansed the wound today with provide iodine (Betadine) solution. Which intervention should the nurse implement first? - ANSWER assess airway patency and oxygen saturation
A client experiences an ABO incompatibility reaction after multiple blood transfusions. Which finding should the nurse report immediately to the health care provider? - ANSWER low back pain and hypotension
1.A young adult male who has had type 2 diabetes mellitus (DM) is admitted to the intensive care unit with hyperglycemic nonketotic syndrome (HHNS). A sliding scale protocol for an isotonic IV solution with regular insulin is prescribed based on the results of a continuous blood glucose monitoring device that is attached to the client's central venous catheter. When the client's respirations become labored and his lungs sound indicate crackles what action should the nurse take? - ANSWER decrease infusion rate to address fluid overload
When preparing to apply a fentanyl (Duragesic) transdermal patch the nurse notes that the previously applied patch is intact on the client's upper back and the client denies pain. What action should the nurse take? - ANSWER Apply a new patch in a different location after removing the original patch
A client who had a myocardial infarction is admitted to the coronary critical care unit (CCU) with a nitroglycerin drip infusing. The clients last blood pressure measurements was 78/36.What action should the nurse implement? - ANSWER reduce the rate of the nitroglycerin infusion
An adolescent is admitted to the hospital because of a suicide attempt with an overdose of acetaminophen (Tylenol). Which blood values are most important for the
nurse to monitor during the first 72 hours following ingestion of this overdose? - ANSWER LDH OR LD, SGOT OR ALT, SGPT OR AST
An elderly post-operative female client is receiving morphine sulfate via a PCA pump. Which assessment finding should prompt a nurse to administer the prescribed
PRN medication naloxone? - ANSWER her respiratory rate is 7 breath/minute
Which assessment finding indicates to the nurse that the muscarinic agent bethanechol (Urecholine) is effective for a client diagnose with urinary retention? - ANSWER urinary output equal to intake
Following involvement in a motor vehicle collision, a middle aged adult client is admitted to the hospital with multiple facial fractures. The client's blood alcohol level is high on admission. Which PRN prescription should be administer if the clients begins to exhibit signs and symptoms of delirium tremens (DT s)? - ANSWER Lorazepam (Ativan) 2mg IM
