ATI RN
ATI Nursing Specialty
1. A client with peripheral arterial disease (PAD) is experiencing muscle pain or cramping during physical activity that resolves with rest. Which of the following symptoms is typically the initial reason clients with PAD seek medical attention?
- A. Intermittent claudication
- B. Dependent rubor
- C. Rest pain
- D. Foot ulcers
Correct answer: A
Rationale: The correct answer is Intermittent claudication. Intermittent claudication, which manifests as muscle pain or cramping during physical activity that improves with rest, is typically the initial reason clients with PAD seek medical attention. Dependent rubor, rest pain, and foot ulcers are more advanced symptoms of PAD and are not usually the initial reasons for seeking medical care.
2. A provider is discharging a client with a prescription for home oxygen therapy. Client and family teaching by the nurse should include all of the following instructions except?
- A. Cleanse the mask or collar with soapy water every other day.
- B. Ensure that the straps on the mask are secure but not too tight.
- C. Apply petroleum jelly around and inside the nares.
- D. Post 'no smoking' warning signs at home in a prominent location.
Correct answer: C
Rationale: When providing instructions for home oxygen therapy, it is important to ensure safety and proper care. Choices A, B, and D are all essential instructions for the client and family. Choice C, 'Apply petroleum jelly around and inside the nares,' is incorrect. Petroleum jelly should not be used near oxygen sources as it is flammable and can increase the risk of fire hazard. Therefore, this instruction should not be included in the teaching.
3. A client who is HIV-positive, has pneumonia and is not responding to antibiotic therapy may have active pulmonary tuberculosis (TB) due to exposure history and symptoms of night sweats and hemoptysis. Which test is the most reliable to confirm the diagnosis of active pulmonary TB?
- A. Chest x-ray
- B. Presence of bronchophony
- C. Mantoux test
- D. Sputum culture for acid-fast bacillus
Correct answer: D
Rationale: The correct answer is D: Sputum culture for acid-fast bacillus. The most reliable test to confirm the diagnosis of active pulmonary TB is the sputum culture for acid-fast bacillus. This test helps identify the presence of Mycobacterium tuberculosis, the causative agent of TB, in the sputum. Chest x-rays can show characteristic findings of TB but are not as reliable as sputum cultures for confirmation. Bronchophony is a test for assessing vocal resonance and is not specific for TB diagnosis. The Mantoux test is a screening test for TB exposure but cannot confirm active disease.
4. A client hospitalized with deep vein thrombosis has been on IV heparin for 5 days. The provider prescribes oral warfarin (Coumadin) without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following is an appropriate nursing response?
- A. The Coumadin takes several days to work, so the IV heparin will be used until the Coumadin reaches a therapeutic level.
- B. I will call the provider to get a prescription for discontinuing the IV heparin today
- C. Both heparin and Coumadin work together to dissolve the clots.
- D. The IV heparin increases the effects of the Coumadin and decreases the length of your hospital stay.
Correct answer: A
Rationale: The correct answer is, 'The Coumadin takes several days to work, so the IV heparin will be used until the Coumadin reaches a therapeutic level.' Warfarin (Coumadin) is an oral anticoagulant that takes time to reach its full effect, typically a few days. In the meantime, IV heparin is used to provide immediate anticoagulation until the Coumadin levels become therapeutic. Option B is incorrect because discontinuing the IV heparin abruptly without reaching a therapeutic level with Coumadin can increase the risk of clot formation. Option C is incorrect because heparin and Coumadin do not work together to dissolve clots; they both have anticoagulant effects but work differently. Option D is incorrect because IV heparin does not directly increase the effects of Coumadin; they have different mechanisms of action.
5. In preparation for the discharge of a client with peripheral arterial disease (PAD), the nurse should include which of the following instructions?
- A. Apply a heating pad on a low setting to help relieve leg pain.
- B. Adjust the thermostat so that the environment is warm.
- C. Wear antiembolic stockings during the day.
- D. Rest with the legs above heart level.
Correct answer: D
Rationale: Resting with the legs above heart level is important for clients with peripheral arterial disease (PAD) to promote better circulation and reduce leg pain. Applying a heating pad on a low setting can actually worsen symptoms by causing burns or increasing blood flow to the area, which is not recommended for PAD. While keeping the environment warm is generally beneficial, it is not a specific instruction for managing PAD. Antiembolic stockings are typically used for preventing blood clots in hospitalized patients and may not be directly related to managing PAD at home.
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