ATI RN
ATI Capstone Medical Surgical Assessment 1 Quizlet
1. What should the nurse do for a patient experiencing abdominal cramping during enema administration?
- A. Lower the height of the enema solution container
- B. Stop the procedure and remove the tubing
- C. Continue the enema at a slower rate
- D. Increase the flow of the enema solution
Correct answer: A
Rationale: When a patient experiences abdominal cramping during enema administration, the nurse should lower the height of the enema solution container. This action helps relieve the cramping by slowing down the flow of the solution. Choice B, stopping the procedure and removing the tubing, is incorrect as it is too drastic and may not address the cramping. Choice C, continuing the enema at a slower rate, may exacerbate the cramping if the flow rate is still too high. Choice D, increasing the flow of the enema solution, would worsen the cramping and is not the appropriate intervention.
2. When planning care for a patient with diabetes insipidus, what should the nurse include in the plan?
- A. Monitor serum albumin levels
- B. Avoid alcohol
- C. Teach the patient to increase fluids
- D. Increase exercise to reduce stress
Correct answer: B
Rationale: The correct answer is B: 'Avoid alcohol.' Alcohol consumption can exacerbate dehydration in patients with diabetes insipidus, so it is essential to advise them to avoid alcohol. Monitoring serum albumin levels (choice A) is not directly related to managing diabetes insipidus. Teaching the patient to increase fluids (choice C) is not recommended as it can worsen the condition by further diluting the urine. Increasing exercise to reduce stress (choice D) is not a primary intervention for managing diabetes insipidus.
3. A patient with chronic kidney disease may require dietary restrictions. Which of the following diets should the healthcare provider prescribe?
- A. Low sodium diet
- B. Potassium restricted diet
- C. High phosphorus diet
- D. High protein diet
Correct answer: B
Rationale: Patients with chronic kidney disease often require a potassium-restricted diet to help manage their electrolyte levels. Excessive potassium intake can be harmful to individuals with compromised kidney function. While monitoring sodium intake is also important for these patients, a low sodium diet is not specifically indicated in the question. High phosphorus diet and high protein diet are not recommended for individuals with chronic kidney disease as they can further stress the kidneys and worsen the condition.
4. What are the expected ECG findings in hypokalemia?
- A. Flattened T waves
- B. Prominent U waves
- C. Elevated ST segments
- D. Wide QRS complex
Correct answer: A
Rationale: Flattened T waves are the classic ECG finding in hypokalemia. Hypokalemia primarily affects the repolarization phase of the cardiac action potential, leading to T wave abnormalities. While prominent U waves are typically associated with hypokalemia as well, flattened T waves are the most specific and sensitive ECG abnormality seen in hypokalemia. Elevated ST segments and wide QRS complexes are not typically seen in hypokalemia and are more indicative of other electrolyte imbalances or cardiac conditions.
5. A patient reports abdominal cramping after enema administration. What action should the nurse take to relieve the discomfort?
- A. Lower the height of the solution container
- B. Increase the flow of enema solution
- C. Remove the enema tubing
- D. Stop the procedure
Correct answer: A
Rationale: The correct action to relieve abdominal cramping after enema administration is to lower the height of the solution container. This adjustment slows down the flow rate of the enema solution, which can help reduce discomfort by decreasing the pressure on the patient's abdomen. Increasing the flow of the enema solution (Choice B) would exacerbate the cramping by introducing more solution quickly. Removing the enema tubing (Choice C) is not necessary to address the cramping, and stopping the procedure (Choice D) may not be needed if adjusting the height of the solution container can resolve the issue.
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