ATI-AMS ATI Adult medical surgical Exam - Set 4 - Part 1

Correct Answer: Confirm the gag reflex has returned

After an EGD the topical anesthetic depresses the gag reflex, so fluids are withheld until it returns. Swallowing without a protective gag reflex risks aspiration, making this assessment essential before anything is taken by mouth. Option b is incorrect because walking helps with comfort later in recovery, yet it does nothing to protect the airway from aspiration. Fluids must still wait for the gag reflex regardless of whether the client is up and moving around. Option c is incorrect because lozenges soothe the sore throat that follows scope passage, but offering them assumes safe swallowing. A suppressed gag reflex means even a lozenge could be aspirated, so this comfort measure is premature. Option d is incorrect because lying flat increases reflux and aspiration risk after sedation. The client should rest with the head elevated, the opposite of this action, so a supine position would worsen rather than support safe recovery.

Correct Answer: Check capillary blood glucose regularly

The hypertonic dextrose in parenteral nutrition raises blood glucose, so regular capillary glucose checks guide supplemental insulin. Monitoring catches the hyperglycemia this therapy commonly produces and protects the client from swings in serum glucose. Option a is incorrect because the parenteral nutrition line is dedicated to that solution alone; running antibiotics through it invites incompatibility and infection. Medications and other fluids belong in a separate access, never the line carrying this nutrient-rich solution. Option b is incorrect because speeding the infusion to make up a deficit causes dangerous shifts in blood glucose and fluid volume. An infusion pump should maintain a steady rate, so deliberately catching up does the opposite of safe practice. Option d is incorrect because the high glucose content feeds bacteria, so tubing and bag are changed daily rather than left for several days. Stretching the interval this far raises the infection risk the shorter schedule

Correct Answer: Pink and moist appearance

A healthy stoma is pink to red and moist, reflecting good blood flow to the tissue. This expected appearance reassures the nurse that perfusion is intact and the new colostomy is healing as it should. Option a is incorrect because a pale dusky color signals reduced blood flow to the stoma and demands prompt intervention. Far from expected, this finding warns of compromised perfusion that the nurse must report rather than accept as normal. Option b is incorrect because deep purple discoloration points to impaired circulation and possible ischemia of the stoma. This is an emergency finding requiring immediate action, the opposite of the healthy perfusion a new colostomy should display. Option c is incorrect because a black, dry stoma indicates necrosis from absent blood supply, a surgical emergency. Rather than something to anticipate, this appearance means tissue death and calls for immediate provider notification.

Correct Answer: Avoid eating within two hours of bedtime

Avoiding food and drink for two hours before bed keeps the stomach empty when the client lies down, reducing nighttime reflux. Combined with an elevated head of the bed, this limits the backflow that irritates the esophagus. Option a is incorrect because reclining after meals lets gastric contents flow back through the incompetent lower esophageal sphincter. The client should instead stay upright, so lying down directly provokes the reflux this teaching aims to prevent. Option b is incorrect because peppermint relaxes the lower esophageal sphincter, which worsens indigestion rather than easing it. Recommending this drink would loosen the very barrier that should stay tight to keep acid out of the esophagus. Option d is incorrect because a tight binder raises intra-abdominal pressure and pushes stomach contents upward. Snug clothing around the abdomen aggravates reflux, the opposite of the loose fit a client with this disorder needs.

Correct Answer: Vasopressin

Vasopressin constricts blood vessels and is given to control active variceal bleeding. By reducing flow through the fragile esophageal veins, it directly addresses the hemorrhage threatening the client with portal hypertension. Option a is incorrect because propranolol is prophylactic, lowering portal pressure to prevent a bleed before it starts. Once hemorrhage is active, this beta-blocker is not the agent of choice, so it does not fit the immediate situation described. Option b is incorrect because metoclopramide increases gastric motility and treats delayed emptying, not bleeding vessels. It has no effect on the engorged esophageal veins, so reaching for it here would leave the hemorrhage uncontrolled. Option c is incorrect because famotidine, a histamine blocker, suppresses gastric acid secretion, which does nothing to halt variceal hemorrhage. The problem is fragile bleeding veins, not acid, so this drug solves a different issue entirely.

Correct Answer: Pain that worsens soon after eating

Gastric ulcer pain typically appears soon after a meal and is worsened by eating. This pattern distinguishes it from a duodenal ulcer and reflects the eroded mucosa being irritated by gastric contents shortly after food. Option a is incorrect because relief with food describes a duodenal ulcer, where eating buffers acid against the lining. A gastric ulcer behaves oppositely, with food provoking pain, so this finding points to a different ulcer location. Option c is incorrect because nighttime pain that wakes the client is characteristic of a duodenal ulcer, which tends to flare when the stomach is empty hours after eating. This pattern does not match the gastric ulcer described in the scenario. Option d is incorrect because clients with gastric ulcers tend to be malnourished and may lose weight because eating triggers discomfort. Weight gain from snacking contradicts the typical presentation, where food makes the pain worse rather than tempting more intake.

Correct Answer: Take the medication on an empty stomach

Sucralfate coats the ulcer to form a protective barrier and works best on an empty stomach, about one hour before meals. Taking it without food present lets the medication adhere directly to the eroded mucosa. Option a is incorrect because taking the drug right after eating places food between the medication and the ulcer surface. Sucralfate needs an empty stomach to bind the lining, so dosing after meals undermines the protective coating it forms. Option b is incorrect because this medication is meant to coat the gastric lining as a barrier, and crushing it into food interferes with that action. The tablet works locally on an empty stomach, not blended into a meal. Option c is incorrect because antacids should be separated from sucralfate because giving them together reduces the binding that creates the protective layer. Combining the two at once defeats the spacing the regimen requires for the coating to work.

Correct Answer: A rigid boardlike abdomen

A rigid boardlike abdomen with rebound tenderness signals perforation and peritonitis, a surgical emergency. Gastric contents spilling into the peritoneum cause this hallmark rigidity, prompting immediate intervention to prevent shock and further deterioration. Option b is incorrect because perforation leads to peritonitis, which typically diminishes or silences bowel sounds rather than increasing them. Heightened bowel activity does not fit this complication, so it would not alert the nurse to a perforated ulcer. Option c is incorrect because blood pressure falls rather than rises as the client moves toward shock from perforation. Expecting hypertension misreads the picture, since hypotension and tachycardia accompany the spreading abdominal catastrophe described here. Option d is incorrect because pain relieved by antacids suggests ordinary ulcer discomfort, not the spreading agony of perforation. A perforated ulcer produces severe, constant pain unresponsive to antacids, so this fin

Correct Answer: 'I will get monthly B12 injections'

Chronic gastritis damages parietal cells, lowering intrinsic factor and impairing vitamin B12 absorption. Lifelong monthly B12 injections bypass the gut to correct the deficiency, so the client's statement reflects accurate understanding of the therapy. Option a is incorrect because oral iron does not correct pernicious anemia, which stems from missing intrinsic factor and poor B12 absorption rather than iron loss. The client has named a supplement that treats a different type of anemia. Option b is incorrect because vitamin K addresses clotting problems, not the B12 deficiency behind pernicious anemia. Choosing this injection confuses two unrelated vitamins, so the statement signals the teaching about the actual deficiency was not understood. Option c is incorrect because the deficiency in intrinsic factor is permanent, so injections continue for life rather than stopping when symptoms ease. Discontinuing them once feeling better would allow the anemia to return, showing a gap in

Correct Answer: Frequent bloody liquid stools

Ulcerative colitis produces frequent liquid stools containing blood, mucus, and pus, with left lower quadrant pain. The continuous inflammation of the rectum and colon mucosa explains the characteristic bloody diarrhea the nurse expects. Option a is incorrect because right lower quadrant pain belongs to Crohn's disease, which targets the distal ileum. Ulcerative colitis localizes to the left lower quadrant, so this finding points to the wrong inflammatory bowel disorder. Option b is incorrect because fistulas are a common complication of Crohn's disease because it affects all bowel layers. Ulcerative colitis stays within the mucosa and submucosa, so fistula formation does not typify the condition described. Option d is incorrect because steatorrhea reflects fat malabsorption seen in Crohn's disease involving the ileum. Ulcerative colitis bleeds from the colon rather than impairing fat absorption, so fatty stools are not the expected finding here.

Correct Answer: 'I will report a sore throat'

Sulfasalazine can cause blood dyscrasias, so a sore throat may warn of low white cells and must be reported. Recognizing this serious adverse effect shows the client understood a key safety instruction for the medication. Option b is incorrect because yellow-orange discoloration of urine and skin is a harmless effect of this drug, not a reason to stop it. Discontinuing the medication over this expected change reflects a misunderstanding of what is actually concerning. Option c is incorrect because the drug is taken after meals with a full glass of water, not two hours afterward. Spacing it that far from food misstates the timing, so the instruction was not correctly understood by the client. Option d is incorrect because black stools indicate gastrointestinal bleeding and should be reported rather than dismissed. Calling them expected and harmless mistakes a warning sign for a benign one, signaling the teaching about adverse effects needs reinforcement.

Correct Answer: Projectile vomiting with a fecal odor

A small-bowel obstruction causes profuse projectile vomiting that may carry a fecal odor as contents back up. This finding, along with metabolic alkalosis from fluid loss, reflects the high blockage the nurse expects. Option a is incorrect because marked lower abdominal distention points to a large-bowel obstruction rather than a small-bowel one. The level of blockage differs, so this finding does not match the high obstruction described in the scenario. Option b is incorrect because ribbon-like stools passing around an impaction occur with large-bowel obstruction, not a small-bowel blockage. This sign reflects a lower obstruction site, so it is not what the nurse would expect to find here. Option d is incorrect because obstruction produces colicky, intermittent pain rather than no pain at all. Expecting a complete absence of discomfort overlooks a key feature of bowel blockage, so this finding is inconsistent with the condition.

Correct Answer: Right upper quadrant pain to shoulder

Cholecystitis classically causes sharp right upper quadrant pain radiating to the right shoulder, often after a fatty meal. Murphy's sign and this pain pattern reflect the inflamed gallbladder the nurse expects to assess. Option b is incorrect because left lower quadrant cramping suggests a colon disorder such as diverticulitis, not gallbladder inflammation. The location is wrong for cholecystitis, whose pain settles in the right upper quadrant near the inflamed organ. Option c is incorrect because burning pain relieved by food describes a duodenal ulcer rather than cholecystitis. Gallbladder pain typically intensifies after fatty meals instead of easing with food, so this pattern fits a different diagnosis. Option d is incorrect because periumbilical bruising points to hemorrhagic pancreatitis, where enzymes seep into tissues. Cholecystitis does not produce this discoloration, so the finding belongs to another abdominal condition rather than the inflamed gallbladder described.

Correct Answer: Leaning forward in a fetal position

Pancreatitis pain eases when the client leans forward or curls into a fetal position, which reduces tension on the inflamed pancreas. Pain worsens lying flat, so this forward-leaning posture brings the relief the nurse anticipates. Option a is incorrect because lying flat intensifies pancreatitis pain by stretching the abdomen and increasing pressure on the gland. Rather than offering comfort, the supine position aggravates the boring epigastric pain the client is trying to relieve. Option b is incorrect because a right side-lying position with extended legs does not relieve the pain of an inflamed pancreas. Comfort comes from leaning forward or curling up, so this flat, extended posture fails to ease the discomfort. Option c is incorrect because standing and walking do not address the deep epigastric pain of pancreatitis and may be intolerable during an acute attack. The client finds relief by leaning forward, not by remaining upright and ambulating.

Correct Answer: Take enzymes with each meal

Pancreatic enzymes must be taken with every meal and snack so they are present to aid fat and protein digestion. Following each dose with a full glass of water ensures the medication reaches the stomach to do its work. Option a is incorrect because taking the enzymes without food defeats their purpose, since they must mix with meals to digest nutrients. An empty stomach leaves nothing for them to act on, so this timing contradicts how the drug works. Option b is incorrect because the medication should be swallowed whole rather than chewed, which can irritate the mouth and reduce effectiveness. Chewing the tablets goes against proper administration, so the nurse would not include this instruction. Option d is incorrect because the contents are sprinkled on nonprotein foods, not high-protein ones, because the enzymes break down protein and can react with it. Choosing protein-rich foods misuses the medication and is not the correct instruction.

Correct Answer: Asterixis and a change in orientation

Rising ammonia in cirrhosis produces asterixis, fetor hepaticus, and changes in orientation, the markers of hepatic encephalopathy. These neurologic signs prompt treatment with lactulose, so the nurse recognizes them as the developing complication. Option a is incorrect because jaundice reflects impaired bilirubin handling in liver disease but is not specific to encephalopathy. While it signals liver dysfunction, it does not indicate the ammonia-driven neurologic changes that define this particular complication. Option c is incorrect because ascites results from portal hypertension and low albumin, a manifestation of liver failure rather than encephalopathy. A distended abdomen shows fluid shifting, not the altered mental status and asterixis the nurse is screening for. Option d is incorrect because anorexia and fatigue are general features of liver dysfunction seen across many stages. They lack the specificity of asterixis and disorientation, so they do not by themselves signal the on

Correct Answer: 'It spreads through the fecal-oral route'

Hepatitis A is transmitted by the fecal-oral route, often through contaminated food or water such as shellfish. Teaching about hand hygiene and food safety addresses this transmission pattern, making it the accurate information for the client. Option a is incorrect because blood-borne spread describes hepatitis B and C, not hepatitis A. Attributing transmission to blood contact misidentifies the route for this virus, which moves through contaminated stool, food, and water instead. Option b is incorrect because the need for coinfection applies to hepatitis D, which depends on hepatitis B to replicate. Hepatitis A spreads independently by the fecal-oral route, so the requirement for another virus does not apply here. Option c is incorrect because respiratory droplet spread is not how hepatitis A is transmitted, so a mask is unnecessary. The virus travels through the fecal-oral route, meaning droplet precautions address a transmission pathway this infection does not use.

Correct Answer: 'It uses no contrast or enema'

A KUB x-ray detects renal calculi using a plain film that requires no contrast and no bowel prep. The client lies supine for this simple, low-risk study, so the nurse explains it needs neither dye nor an enema. Option a is incorrect because the KUB requires no special preparation, so fasting after midnight is unnecessary. That instruction belongs to contrast studies such as excretory urography, not to this plain film that simply images the abdomen for stones. Option c is incorrect because the client lies supine for a KUB, not prone, during the brief x-ray. Describing a prone position misstates how the study is performed, so this information would not be part of accurate teaching. Option d is incorrect because no contrast dye is used in a KUB, so the client will not feel the warm flush associated with injected contrast. That sensation occurs with contrast studies, making this statement inaccurate for the plain film described.

Correct Answer: Hemorrhage

The kidney is highly vascular and the puncture site cannot be compressed, so hemorrhage is the greatest risk after a biopsy. The nurse monitors closely for bleeding, making it the priority concern in the immediate recovery period. Option b is incorrect because infection can occur after any invasive procedure but develops over time rather than threatening the client immediately. It lacks the urgency of bleeding from a vascular organ, so it does not represent the greatest early risk. Option c is incorrect because pain is expected after the biopsy and is managed with analgesics, but it does not endanger the client's life. Unlike hemorrhage, discomfort is a comfort issue rather than the most serious complication to anticipate. Option d is incorrect because some hematuria is common after a kidney biopsy and often resolves, whereas frank hemorrhage is the dangerous concern. Mild blood-tinged urine is monitored, but it ranks below the brisk bleeding that poses the greatest threat.

Correct Answer: Avoid blood pressure in that arm

Blood pressure measurement, venipuncture, and IV insertion are avoided in the fistula arm to protect the access from damage and clotting. Keeping that arm free of pressure and needlesticks preserves the lifeline the client needs for dialysis. Option a is incorrect because drawing blood from the fistula arm risks clotting and injury to the access. Samples should be taken elsewhere, so using this arm for venipuncture endangers the very access the client depends on for treatment. Option c is incorrect because starting an IV in the fistula arm threatens the access with infection and clotting. The unaffected arm should be used for intravenous lines, so placing one in the fistula forearm violates a basic protective rule. Option d is incorrect because a tight dressing can compress the fistula and impair the blood flow that keeps it patent. The access needs an audible bruit and palpable thrill, which constriction would compromise, so this action risks losing the fistula.