ATI-AMS ATI Adult medical surgical Exam - Set 5 - Part 1

Correct Answer: I will stay in bed afterward

After a bone marrow biopsy the client maintains bed rest for a short period while pressure and ice control bleeding at the puncture site, so staying in bed afterward reflects correct understanding. Option a is incorrect because lying flat on the back is the wrong position for this procedure; the iliac crest is reached with the client prone or side-lying so the marrow can be sampled, not supine, making this a misunderstanding to correct. Option b is incorrect because general anesthesia is not used for marrow sampling. The site is numbed with a local anesthetic and a sedative may be given, which keeps the client comfortable yet awake rather than fully unconscious during the biopsy. Option d is incorrect because aspirin interferes with clotting and is specifically withheld after this procedure because it raises bleeding risk at the puncture site; only mild non-aspirin analgesics are appropriate, so planning to take aspirin signals a teaching gap.

Correct Answer: INR

Warfarin response is tracked with the PT and its standardized INR, which guide dose adjustment toward the therapeutic goal. A subtherapeutic INR means the dose should be raised to reach effective anticoagulation. Option a is incorrect because activated partial thromboplastin time gauges the response to heparin, not warfarin; using it to adjust a warfarin dose would leave this client's oral anticoagulation effect unmonitored and the dose poorly controlled. Option c is incorrect because this test detects clot breakdown and helps rule out a pulmonary embolus or evaluate disseminated intravascular coagulation. It says nothing about how well warfarin is anticoagulating the client and cannot guide dosing. Option d is incorrect because elevated fibrin degradation products point toward disseminated intravascular coagulation or massive trauma. This result reflects abnormal clot lysis rather than the controlled effect of warfarin that the nurse needs to follow.

Correct Answer: The warfarin dose will be increased

An INR below the therapeutic range means the client is under-anticoagulated and still at risk for clotting, so the provider raises the warfarin dose to bring the value into the goal range and provide protection. Option a is incorrect because lowering the dose is the response to an INR that is too high and signals over-anticoagulation. Reducing it here would push the value even lower and leave the client more vulnerable to thrombus formation. Option b is incorrect because vitamin K reverses warfarin and is reserved for dangerous over-anticoagulation with bleeding. Giving it to a client whose INR is already subtherapeutic would worsen the inadequate effect and defeat the purpose of therapy. Option c is incorrect because stopping the medication abandons the reason it was prescribed. A subtherapeutic result calls for adjustment toward the goal rather than withdrawal, which would remove the client's only clot prevention entirely.

Correct Answer: Isotonic sodium chloride

Only isotonic sodium chloride is compatible with blood products. It keeps the cells intact within the Y-tubing, while medications and other fluids are never added because they can damage the red blood cells. Option b is incorrect because dextrose in water is hypotonic once the sugar is metabolized and causes red blood cells to swell and hemolyze. Running it with blood would destroy the very cells the transfusion is meant to deliver. Option c is incorrect because lactated Ringer's contains calcium, which can bind the citrate anticoagulant in the unit and trigger clot formation in the line. For that reason it is not paired with a blood transfusion. Option d is incorrect because half-strength saline is hypotonic and would shift fluid into the red blood cells, causing them to rupture. The required priming fluid is full-strength isotonic saline, the only solution that is safe with blood.

Correct Answer: Have two RNs verify the product

Two registered nurses must compare the blood product, the prescription, and the client's identification together, and one of those two nurses is the one who administers the unit. This double check prevents a deadly incompatibility reaction before infusion begins. Option a is incorrect because verifying a blood product is outside an assistive personnel's scope; this safety check requires two licensed nurses. Delegating it would remove the professional judgment that catches mismatched units before harm occurs. Option b is incorrect because nothing is ever added to a blood unit, including antibiotics, because additives can damage the cells or cause clumping. Medications are given separately through a different line, never mixed into the transfusion itself. Option d is incorrect because dextrose lyses red blood cells, so it is never used to prime blood tubing. The line must be primed with isotonic saline, making this a step that would harm rather than safely prepare the transfusi

Correct Answer: Stop the transfusion

Chills with low-back pain early in a transfusion suggest an acute hemolytic reaction from incompatibility. Stopping the infusion immediately halts the entry of more incompatible blood, which is the priority before any other intervention. Option b is incorrect because merely slowing the rate keeps incompatible blood flowing into the client and allows the hemolytic process to progress. The reaction demands a complete halt, not a reduction, to limit the volume of mismatched cells delivered. Option c is incorrect because an antipyretic treats fever from a febrile reaction but does nothing to address the life-threatening incompatibility unfolding here. Stopping the blood comes before any medication so the trigger is removed first. Option d is incorrect because the provider does need to be informed, yet contacting them before halting the infusion wastes critical time while incompatible blood continues to enter the client. The nurse stops the transfusion, then notifies.

Correct Answer: Diphenhydramine

Itching and urticaria indicate a mild allergic transfusion reaction. After stopping the transfusion and maintaining saline through new tubing, the nurse anticipates an antihistamine such as diphenhydramine to counter the histamine-driven symptoms. Option a is incorrect because epinephrine is reserved for anaphylaxis with bronchospasm, laryngeal edema, or shock. This client has only mild itching and hives without airway or circulatory collapse, so the powerful response of epinephrine is not yet warranted. Option c is incorrect because furosemide manages circulatory overload, which presents with crackles, distended neck veins, and dyspnea from too much volume. It would do nothing for an allergic skin reaction that is driven by histamine release. Option d is incorrect because an antibiotic addresses a bacterial reaction from contaminated blood, marked by wheezing, hypotension, and shock. Hives and itching reflect allergy rather than infection, so antimicrobial therapy targets the wrong pr

Correct Answer: Position the client upright with feet down

Crackles, dyspnea, and neck vein distention signal circulatory overload. Slowing or stopping the blood and placing the client upright with the feet down eases the work of breathing and reduces venous return to the overloaded heart. Option a is incorrect because lying flat with legs raised increases venous return and floods an already overloaded circulation, worsening the pulmonary congestion. This position helps hypotension, not the fluid excess this client is experiencing right now. Option b is incorrect because speeding up the infusion delivers more volume to a heart that cannot handle the current load, driving the client toward pulmonary edema. The rate must be slowed or stopped, never increased, in overload. Option d is incorrect because warm compresses offer no benefit for fluid overload and ignore the underlying circulatory problem. The client needs upright positioning, oxygen, and diuretics to move excess volume, not local heat applied to the chest.

Correct Answer: Platelets do not require blood type matching

Platelets do not need to be matched to the client's blood type and are infused immediately over a short period using a special set with a small filter, which preserves their function and clotting ability. Option a is incorrect because platelets are given quickly, within a short window, not slowly over several hours. A prolonged infusion would let the platelets deteriorate and lose the clotting benefit that the client urgently needs. Option b is incorrect because platelets are administered through a special set with a small filter, not a large-bore filter intended for red blood cells. The small filter protects the fragile platelets during their rapid infusion. Option c is incorrect because cross-matching applies to red-blood-cell-containing products to prevent hemolysis. Platelets are an exception and do not need this compatibility testing, so describing them as cross-matched misstates how they are prepared.

Correct Answer: I can donate weekly if stable

Autologous donation uses the client's own blood, collected starting weeks before surgery and weekly as long as the hemoglobin and hematocrit remain stable, so donating each week when counts allow shows correct understanding. Option a is incorrect because a sibling's blood would be a standard donation, not autologous. The defining feature of autologous donation is that the blood comes from the client alone, so relying on a relative misunderstands the concept entirely. Option c is incorrect because autologous units are reserved exclusively for the donor and cannot be transfused into other clients. Believing the blood is available for others contradicts the whole purpose of banking one's own blood ahead of surgery. Option d is incorrect because collection begins weeks before the procedure to allow the body to replenish, not the day before surgery. Waiting until the last day leaves no time to rebuild and bank adequate units for the operation.

Correct Answer: Spoon-shaped nails

Iron-deficiency anemia produces pallor of the nail beds and characteristic spoon-shaped nails, along with a smooth tongue. These integumentary changes reflect the reduced oxygen delivery and iron stores that define the disorder. Option a is incorrect because yellow mucous membranes indicate jaundice from elevated bilirubin, a liver or hemolytic problem, rather than iron deficiency. This finding points to a different process and is not part of the anemia picture being assessed. Option b is incorrect because shiny, hairless skin on the lower legs reflects peripheral arterial disease and chronic poor circulation to the extremities. It results from arterial insufficiency, not from the low iron stores seen in this particular anemia. Option c is incorrect because tenting of the skin demonstrates poor turgor from dehydration and fluid loss. It signals volume depletion rather than the chronic oxygen-carrying deficit of iron-deficiency anemia, so it belongs to a separate assessment finding.

Correct Answer: Vitamin C helps my body absorb iron

Vitamin C enhances iron absorption, so taking the supplement with a source of vitamin C and between meals improves uptake. Recognizing this benefit shows the client understands how to make the therapy effective. Option b is incorrect because oral iron darkens stools to a green or black color, not bright red. Expecting red stools could cause the client to mistake the harmless expected change for bleeding, so this reflects a misunderstanding to correct. Option c is incorrect because milk decreases iron absorption, so pairing the supplement with it undermines the therapy. Iron is best taken between meals and with vitamin C, making the choice to drink milk with it counterproductive for the client. Option d is incorrect because iron replacement works gradually, and hemoglobin is rechecked after several weeks; relief is not immediate. Expecting improvement within a few days sets an unrealistic timeline and signals incomplete understanding of the treatment.

Correct Answer: I will need lifelong injections

Without intrinsic factor, this vitamin cannot be absorbed from the gut, so the client requires lifelong monthly injections or a daily intranasal form. Recognizing the need for a parenteral route shows correct understanding of the therapy. Option a is incorrect because oral tablets fail because the missing intrinsic factor is exactly what allows this vitamin to be absorbed through the intestine. Swallowing it would simply pass it through unabsorbed, leaving the deficiency uncorrected over time. Option b is incorrect because dietary sources from red meat still depend on intrinsic factor for absorption, which this client no longer produces. Increasing food intake cannot fix a problem that lies in the absorption pathway rather than in intake. Option c is incorrect because iron addresses microcytic anemia, whereas the loss of intrinsic factor causes a macrocytic deficiency of a different nutrient. Supplementing iron targets the wrong substance and would leave the underlying absorption defec

Correct Answer: Hemoglobin will be checked twice weekly

Epoetin alfa stimulates red blood cell production, so hemoglobin and hematocrit are checked about twice weekly until target levels are reached, and blood pressure is watched because a rapid rise raises cardiovascular risk. Option a is incorrect because daily potassium monitoring is not the focus with this medication; the key labs are hemoglobin and hematocrit. Centering teaching on potassium would miss the parameters that actually gauge whether the drug is working safely. Option b is incorrect because therapy continues until the target hemoglobin is achieved rather than ending as soon as the client feels better. Stopping early at symptom relief would interrupt the gradual rebuilding of red blood cells that the drug promotes. Option d is incorrect because blood glucose is not the parameter affected by erythropoietin; blood pressure is, because of the cardiovascular risk from a fast hemoglobin rise. Emphasizing glucose directs monitoring toward an unrelated value.

Correct Answer: Assist the client with ambulation

Severe anemia with orthostatic dizziness threatens client safety, so assisting with ambulation, monitoring oxygen saturation, and scheduling rest periods protect against falls while the underlying oxygen deficit is treated. Option b is incorrect because clients with anemia are weighed daily, not weekly, to detect fluid changes and complications such as developing heart failure. A weekly schedule would miss early shifts and does not address the immediate fall hazard from dizziness. Option c is incorrect because limiting fluids does not treat anemia and could worsen orthostatic symptoms by reducing circulating volume. Adequate hydration supports blood pressure on standing, so fluid restriction works against the client's safety here. Option d is incorrect because encouraging fast position changes invites a sudden drop in cerebral perfusion and a fall in this already dizzy client. Teaching slow, gradual movement is what protects against syncope, making rapid changes harmful advice.

Correct Answer: Low platelet count and low fibrinogen

In disseminated intravascular coagulation, clotting consumes platelets and fibrinogen while breakdown products rise, so the nurse expects decreased platelets and fibrinogen along with prolonged PT and aPTT and elevated D-dimer. Option a is incorrect because platelets and fibrinogen fall rather than rise in this disorder because they are used up by widespread microclotting. Expecting both to be elevated reverses the actual pattern of consumption that defines the condition. Option b is incorrect because values such as D-dimer and PT are both elevated, not normal, because clots form and break down at once and clotting factors are depleted. Normal results would not fit the active clotting and bleeding of this emergency. Option c is incorrect because hemoglobin tends to fall from bleeding while clot lysis drives the D-dimer sharply up. A high hemoglobin paired with a low D-dimer contradicts the simultaneous clotting and hemorrhage seen in this process.

Correct Answer: Heparin

Heparin is anticipated in disseminated intravascular coagulation because it limits the microclot formation that consumes clotting factors. Slowing this microclotting helps preserve factors and interrupts the cycle of simultaneous clotting and bleeding. Option a is incorrect because vitamin K promotes coagulation, which is the opposite of what is needed when microclots are already forming and consuming factors. Giving it would feed the clotting cascade rather than calm the runaway process. Option b is incorrect because simvastatin is an antilipemic that lowers cholesterol and has no role in interrupting the clotting of this disorder. Choosing it confuses a lipid-lowering agent with the anticoagulation the client actually requires. Option d is incorrect because an antibiotic might treat an underlying infection that triggered the condition, but it does not act on clot formation itself. The microclotting is addressed by heparin, not by antimicrobial therapy aimed at bacteria.

Correct Answer: Report the finding to the provider immediately

Cyanotic nail beds indicate microvascular clotting that can lead to ischemic loss of fingers, so the nurse reports this finding immediately. Prompt action protects the digits from permanent damage caused by obstructed blood flow. Option a is incorrect because cyanotic nail beds are not ordinary bruising; they reveal blocked circulation to the digits that threatens tissue viability. Dismissing the finding as expected would delay the urgent intervention these fingers require to survive. Option b is incorrect because a warm soak with delayed rechecking wastes time while ischemic tissue continues to die from obstructed flow. This finding calls for immediate provider notification, not a watchful home-style measure that simply postpones treatment. Option c is incorrect because range of motion exercises do nothing to restore the blocked microcirculation causing the cyanosis and divert attention from the real emergency. The priority is reporting the ischemic change so perfusion can be addresse

Correct Answer: Stopping the heparin

A dropping platelet count after more than a week of heparin suggests heparin-induced thrombocytopenia, so the heparin is stopped and a direct thrombin inhibitor is started. Removing the trigger halts the immune-mediated platelet destruction. Option b is incorrect because raising the dose intensifies exposure to the very drug causing the immune reaction and worsens both the platelet drop and the clotting risk. The trigger must be withdrawn, so increasing heparin moves in exactly the wrong direction. Option c is incorrect because routine platelet transfusion is not the treatment for this disorder and can promote further clotting in an already prothrombotic state. The essential step is discontinuing heparin and switching to a direct thrombin inhibitor. Option d is incorrect because warfarin alone is not started during the acute phase because it can worsen clotting before it becomes effective. The immediate management centers on stopping heparin and using a direct thrombin inhibitor instea

Correct Answer: Use an electric razor for shaving

Bleeding precautions for a low platelet count include using an electric razor to avoid cuts, applying prolonged pressure after needle sticks, and avoiding NSAIDs, all of which lower the chance of uncontrolled bleeding. Option a is incorrect because ibuprofen is an NSAID that impairs platelet function and increases bleeding, so it is specifically avoided in clients with low platelets. Recommending it would add to the very risk the precautions aim to prevent. Option c is incorrect because vigorous flossing can injure the gums and provoke bleeding in a client whose platelets are already too low to control it. Gentle oral care is advised instead, making aggressive flossing an unsafe instruction here. Option d is incorrect because bearing down performs a Valsalva maneuver that raises pressure and risks cerebral hemorrhage in a client prone to bleeding. Stool softeners and avoiding straining are taught, so firm bearing down is contraindicated.