a nurse is caring for a client after bariatric surgery and is assessing for hemorrhage what is a sign of hemorrhage

ATI LPN

Medical Surgical ATI Proctored Exam

1. A patient is being cared for after bariatric surgery, and the healthcare provider is assessing for hemorrhage. What is a sign of hemorrhage?

A. Increase in blood pressure
B. Frank red bleeding from the surgical site
C. Clear drainage from the surgical wound
D. Decrease in heart rate

Correct answer: B

Rationale: Frank red bleeding from the surgical site is a significant sign of hemorrhage that warrants immediate attention. It indicates active bleeding that needs to be addressed promptly to prevent further complications.

2. Which regimen is most effective for treating H. pylori infection?

A. Metronidazole, bismuth subsalicylate, amoxicillin for 14 days
B. Clarithromycin and omeprazole for 14 days
C. Metronidazole, lansoprazole, and clarithromycin for 14 days
D. Metronidazole, clarithromycin, and omeprazole for 7 days

Correct answer: C

Rationale: Regimen C, which consists of metronidazole, lansoprazole, and clarithromycin for 14 days, is recommended by the FDA as an effective treatment for H. pylori infection. This regimen has been shown to have a high eradication rate and is a standard recommendation in clinical practice guidelines for the management of H. pylori-related conditions.

3. A recently widowed middle-aged female client presents to the psychiatric clinic for evaluation and tells the nurse that she has 'little reason to live.' She describes one previous suicidal gesture and admits to having a gun in her home. To maintain the client's confidentiality and to help ensure her safety, which action is best for the nurse to implement?

A. Encourage the client to remove the gun from her possession.
B. Notify the client's healthcare provider of the availability of the weapon.
C. Contact a person of the client's choosing to remove the weapon from the home.
D. Call the local police department and have the weapon removed from the home.

Correct answer: C

Rationale: In this scenario, it is crucial to maintain the client's confidentiality while ensuring her safety. Contacting a person chosen by the client to remove the weapon from her home is the best course of action. This approach respects the client's autonomy and helps reduce the risk of harm without involving external authorities unnecessarily.

4. The nurse is planning care for a 16-year-old with juvenile rheumatoid arthritis (JRA). The nurse includes activities to strengthen and mobilize the joints and surrounding muscles. Which physical therapy regimen should the nurse encourage the adolescent to implement?

A. Exercise in a swimming pool.
B. Splint affected joints during activity.
C. Perform passive range of motion exercises twice daily.
D. Begin a training program of lifting weights and running.

Correct answer: A

Rationale: Exercising in a swimming pool is beneficial for adolescents with juvenile rheumatoid arthritis as it reduces stress on the joints while allowing movement and strengthening. The buoyancy of water supports the body, making exercises easier and less painful, while also providing resistance to strengthen muscles. This form of exercise can help improve joint mobility and overall function without causing excessive strain on the joints. Choices B, C, and D are incorrect because splinting affected joints, performing passive range of motion exercises, or beginning a training program of lifting weights and running can potentially exacerbate symptoms and cause additional stress on the joints, which is not recommended for individuals with juvenile rheumatoid arthritis.

5. A client with a history of deep vein thrombosis (DVT) is receiving warfarin (Coumadin). Which laboratory value indicates a therapeutic effect of the medication?

A. INR of 2.5.
B. PTT of 45 seconds.
C. Hemoglobin of 12 g/dL.
D. Platelet count of 150,000/mm³.

Correct answer: A

Rationale: An INR (International Normalized Ratio) of 2.5 indicates a therapeutic level for clients receiving warfarin (Coumadin) to prevent thromboembolism. It is essential to monitor INR levels regularly when on warfarin therapy to ensure that the blood's ability to clot is within the desired range to prevent both clotting and excessive bleeding.