ATI-AMS ATI Adult medical surgical Exam - Set 4 - Part 2

Correct Answer: Cloudy dialysate outflow

Cloudy or opaque effluent is the earliest sign of peritonitis in peritoneal dialysis. Detecting this change prompts surgical asepsis and provider notification, so the nurse treats cloudy outflow as the key warning of infection. Option a is incorrect because clear, light-yellow outflow is the normal expected return and signals no infection. Rather than warning of peritonitis, this appearance reassures the nurse that the dialysate is draining cleanly as it should. Option b is incorrect because outflow that matches or exceeds inflow indicates proper drainage, not infection. Adequate return volume is a goal of the therapy, so this finding reflects effective exchange rather than the cloudy effluent that signals peritonitis. Option d is incorrect because warming the dialysate before instillation is correct technique and unrelated to infection. A warmed solution improves comfort and flow, so it is a care step rather than a sign of the complication being identified.

Correct Answer: A steadily decreasing hourly urine output

After a transplant, the new kidney should produce a steady urine output, so a falling or scant output may signal rejection, thrombosis, or obstruction. Oliguria is not expected, so the nurse reports it immediately to protect the graft. Option b is incorrect because urine that starts pink or bloody and gradually clears is the expected course after transplant surgery. This normal progression reflects healing rather than a complication, so it does not require urgent reporting to the provider. Option c is incorrect because a rising urine output reflects the new kidney beginning to function, a reassuring sign. Although marked diuresis is watched for fluid loss, increasing output itself contrasts with the oliguria that truly demands immediate notification. Option d is incorrect because a small amount of bloody drainage from the surgical wound is anticipated and assessed routinely. Unlike low urine output, minor expected drainage does not point to graft failure, so it lacks the urgency of oli

Correct Answer: 'I will avoid drinking grapefruit juice'

Grapefruit juice raises cyclosporine levels and increases toxicity, so avoiding it shows the client understood the teaching. Steering clear of grapefruit keeps the immunosuppressant within a safe range to protect both the client and the graft. Option a is incorrect because protein is needed for healing after transplant, so reducing it works against recovery. The teaching encourages adequate protein, meaning this statement reflects a misunderstanding of the dietary needs following surgery. Option c is incorrect because a sore throat may signal infection in an immunosuppressed client and must be reported. Dismissing it overlooks a serious risk, so the statement shows the client did not grasp the importance of monitoring for infection. Option d is incorrect because cyclosporine lowers magnesium, so supplements are often needed rather than strict avoidance. Cutting out magnesium would deepen the deficiency the drug causes, so this statement misreads the medication's effect on electrol

Correct Answer: It requires immediate kidney removal

Hyperacute rejection occurs almost immediately after transplant from antibody-mediated clotting and is not reversible, so the donor kidney must be removed immediately. The nurse teaches that this early, severe reaction requires prompt surgical removal of the graft. Option b is incorrect because increasing immunosuppressants treats acute rejection, which appears between one week and two years. Hyperacute rejection cannot be reversed with higher doses, so this approach applies to a different and later type of rejection. Option c is incorrect because gradual onset over months describes chronic rejection from fibrosis, not the hyperacute form. Hyperacute rejection strikes almost immediately, so a slow timeline misidentifies which rejection the teaching is describing. Option d is incorrect because plasmapheresis does not reverse hyperacute rejection, which is irreversible once the antibody-mediated clotting destroys the graft. Removal of the kidney is the only response, so suggesting a reve

Correct Answer: Tall peaked T waves

Acute kidney injury causes potassium to accumulate, and tall peaked T waves are the classic ECG change of hyperkalemia. Watching for this pattern lets the nurse catch a rising potassium before it triggers dangerous dysrhythmias. Option a is incorrect because a shortened QT interval is associated with high calcium rather than high potassium. Since the concern in this client is hyperkalemia from failing kidneys, this finding does not reflect the electrolyte change being monitored. Option b is incorrect because absent P waves with bradycardia is not the hallmark of hyperkalemia, which characteristically produces tall peaked T waves. Focusing on this pattern would overlook the specific ECG change that signals rising potassium in kidney injury. Option c is incorrect because inverted T waves with chest pain suggest cardiac ischemia, not the electrolyte disturbance of kidney injury. This finding points to a coronary problem, so it does not represent the hyperkalemia the nurse is watching for.

Correct Answer: Administering an IV fluid challenge

Prerenal injury results from poor perfusion, and early fluid restoration can reverse it before kidney damage occurs. A fluid challenge restores volume and renal blood flow, so the nurse anticipates this intervention for hypovolemia-driven injury. Option a is incorrect because iodinated contrast is nephrotoxic and contraindicated in a client whose kidneys are already compromised. A contrast CT would risk further injury, so it works against the goal of restoring rather than harming kidney function. Option b is incorrect because NSAIDs reduce renal blood flow and can worsen or even cause prerenal injury. Giving one to a client with hypovolemic kidney injury would deepen the perfusion problem, so this medication is avoided rather than anticipated. Option d is incorrect because the appropriate position for hypotension in this setting is reverse Trendelenburg, not Trendelenburg. Placing the client head-down does not restore renal perfusion the way fluid does, so it is not the anticipated int

Correct Answer: Give the digoxin after the dialysis session

Digoxin is given after dialysis because the procedure can remove the drug and alter potassium, affecting its action. Dosing afterward maintains a therapeutic level and reduces the toxicity risk that comes with the electrolyte shifts of dialysis. Option a is incorrect because giving digoxin right before dialysis allows the procedure to remove part of the dose, leaving a subtherapeutic level. The medication should follow treatment instead, so dosing beforehand undermines the effect the drug is meant to have. Option b is incorrect because doubling the dose risks toxicity, especially as dialysis shifts potassium and changes digoxin sensitivity. The correct approach is timing the standard dose after treatment, not increasing it, so this action endangers the client. Option c is incorrect because holding digoxin permanently denies the client a medication that may be managing a cardiac condition. The drug is timed around dialysis rather than discontinued, so stopping it altogether is not the a

Correct Answer: Controlling the client's blood pressure

Controlling blood pressure is the highest priority in polycystic kidney disease because hypertension from cyst-related ischemia accelerates kidney damage. Managing it protects remaining function, so the nurse focuses care on keeping blood pressure within target. Option b is incorrect because high-impact exercise risks injuring enlarged, cyst-filled kidneys and could rupture a cyst. Rather than a priority, vigorous activity poses a hazard, so the focus stays on blood pressure control instead of strenuous exercise. Option c is incorrect because fiber is actually encouraged to prevent the constipation common in this disorder, so restricting it is counterproductive. This action addresses the wrong concern entirely, while blood pressure control targets the real threat to kidney function. Option d is incorrect because fluids are generally encouraged, not limited, and restricting them does not stop cyst growth. The misconception that fluid restriction helps overlooks the true priority, which

Correct Answer: Administer the prescribed antibiotic

Giving the antibiotic is the priority because untreated infection can ascend to the kidneys and progress to urosepsis. Addressing the infection directly carries the greatest urgency, so the medication comes before comfort and supportive measures. Option a is incorrect because a warm sitz bath eases perineal discomfort but does nothing to eradicate the bacteria. Comfort measures support the client, yet they cannot prevent the infection from spreading, so they rank below the antibiotic. Option b is incorrect because cranberry juice may help discourage bacterial adherence over time but does not treat an active infection. Because it lacks the urgency of stopping the infection, it is a supportive step rather than the priority action. Option c is incorrect because extra fluids help flush the urinary tract and are encouraged, but they do not kill the organisms causing the infection. Hydration assists recovery while the antibiotic does the essential work of clearing the infection.

Correct Answer: 'I will wipe front to back'

Wiping front to back keeps bacteria from the rectum away from the urethra, lowering infection risk. This habit, along with adequate fluids and prompt voiding, reflects the client's understanding of how to prevent recurrent urinary infections. Option a is incorrect because cotton underwear is recommended because synthetic fabrics trap moisture that promotes bacterial growth. Choosing nylon works against prevention, so this statement signals the client did not understand the clothing guidance in the teaching. Option b is incorrect because sitting in a wet bathing suit creates a warm, moist environment that encourages bacteria near the urethra. The client should change promptly instead, so planning to stay in a wet suit reflects a misunderstanding of the teaching. Option d is incorrect because holding urine allows bacteria to multiply in the bladder rather than being flushed out. The client should void every few hours and with the urge, so retaining urine contradicts the prevention s

Correct Answer: Costovertebral angle tenderness

Pyelonephritis inflames the kidney pelvis and produces flank pain with costovertebral angle tenderness. This finding, along with fever and chills, reflects the upper urinary tract infection the nurse expects when assessing the client. Option b is incorrect because cola-colored urine with protein points to glomerulonephritis, an immunologic injury to the glomeruli. Pyelonephritis is a bacterial kidney infection marked by flank tenderness, so this finding belongs to a different renal disorder. Option c is incorrect because painless bladder distention suggests urinary retention rather than the infection of the kidney pelvis. Pyelonephritis causes flank pain and tenderness, so a distended bladder without pain does not match the condition described. Option d is incorrect because an elevated antistreptolysin O titer follows a streptococcal infection and supports glomerulonephritis. It is not a feature of pyelonephritis, so this lab finding points away from the bacterial kidney infection bein

Correct Answer: Strain all of the client's urine

Straining all urine captures the calculus once it passes so it can be analyzed to guide prevention. This simple action ensures the stone is not lost, making laboratory analysis and targeted dietary teaching possible. Option a is incorrect because fluids are increased to a large daily volume to help flush the stone through, not restricted. Limiting intake would slow passage and concentrate the urine, working directly against the goal of moving the calculus along. Option b is incorrect because ambulation is encouraged because movement helps the stone travel down the urinary tract. Strict bed rest removes that benefit, so keeping the client immobile hinders rather than helps the stone's passage. Option d is incorrect because restricting movement does not relieve renal colic and removes the help that walking provides for passage. The client is encouraged to move, so limiting activity opposes the care that promotes the stone moving through.

Correct Answer: Spinach and black tea

Spinach and black tea are high in oxalate, which contributes to calcium oxalate stone formation. Avoiding these oxalate-rich foods helps lower the chance of forming new stones, so the nurse includes them in the teaching. Option a is incorrect because milk and yogurt are limited with struvite stones because of their phosphate content, not with calcium oxalate stones. These dairy foods are not the oxalate sources targeted here, so they are the wrong foods to avoid. Option b is incorrect because white bread and pasta are low in oxalate and not a concern for this stone type. They do not raise oxalate levels, so instructing the client to avoid them would misdirect the dietary teaching. Option c is incorrect because lean poultry relates to purine restriction for uric acid stones rather than oxalate restriction. Since chicken and turkey are not high in oxalate, they are not the foods a client forming calcium oxalate stones should avoid.

Correct Answer: Large volumes of dilute urine

Diabetes insipidus results from an ADH deficiency, so the kidneys cannot concentrate urine and excrete large volumes of dilute urine. This polyuria with a low specific gravity and intense thirst is what the nurse expects to find. Option a is incorrect because concentrated, low-volume urine occurs in SIADH, where excess ADH causes water retention. Diabetes insipidus produces the opposite picture of dilute, copious urine, so this finding reflects the contrasting disorder rather than the one described. Option c is incorrect because weight gain without edema is characteristic of SIADH from retained water, not diabetes insipidus. The client with this deficiency loses fluid and tends toward dehydration, so this finding belongs to the opposite condition. Option d is incorrect because a low serum sodium reflects the dilutional hyponatremia of SIADH. In diabetes insipidus the blood becomes concentrated with a rising sodium, so a decreased value points to the reverse fluid imbalance.

Correct Answer: Restricting the client's fluid intake

SIADH causes water retention and dilutional hyponatremia, so restricting fluids is the first priority to reverse the overload. Limiting intake addresses the root problem of excess water before the falling sodium triggers seizures. Option b is incorrect because encouraging free fluids would worsen the water retention and dilutional hyponatremia that define SIADH. This action deepens the overload the nurse is trying to correct, so it is the opposite of the priority intervention. Option c is incorrect because feeding tubes are flushed with saline rather than plain water in SIADH to avoid adding free water. Using water would compound the dilutional state, so this practice undermines the fluid control the client requires. Option d is incorrect because sodium is not withheld in SIADH, where the low level comes from dilution rather than true sodium loss. Cutting sodium intake addresses the wrong problem, since the excess water, not a sodium deficit, drives the imbalance.

Correct Answer: Check your pulse before each dose

Propranolol slows the heart, so the client checks the pulse before each dose and withholds it when the pulse is abnormally slow. This precaution prevents excessive bradycardia while the beta-blocker controls the sympathetic symptoms of hyperthyroidism. Option a is incorrect because propranolol treats the sympathetic effects such as tachycardia but does not alter thyroid hormone levels. Expecting it to lower hormones confuses its role with that of thionamides, so this statement misrepresents how the drug works. Option c is incorrect because a sore throat is a concern with methimazole because of blood dyscrasias, not with propranolol. Stopping the beta-blocker for this symptom misapplies a warning from a different drug, so the instruction is inaccurate here. Option d is incorrect because the medication is taken on a regular schedule to control cardiac symptoms, not just when the client feels anxious. Dosing it only for anxiety would leave the tachycardia untreated, so this as-needed appr

Correct Answer: Acetaminophen

Acetaminophen is used to reduce the hyperthermia of thyroid storm because it lowers temperature without displacing thyroid hormone. This makes it the appropriate antipyretic while the nurse also provides cooling and other emergency measures. Option a is incorrect because aspirin is avoided in thyroid storm because it displaces thyroxine from binding proteins, raising free hormone levels. Giving it would worsen the crisis rather than control the fever, so it is the wrong choice in this emergency. Option b is incorrect because ibuprofen is not the recommended antipyretic for thyroid storm, where acetaminophen is preferred for safe fever reduction. Choosing this drug overlooks the specific agent indicated, so it does not fit the management of this crisis. Option d is incorrect because a magnesium antacid neither lowers temperature nor treats the hypermetabolic surge of thyroid storm. It addresses gastric acid, an unrelated concern, so it has no role in managing the fever that accompanies

Correct Answer: Cold intolerance and constipation

Hypothyroidism lowers the metabolic rate, producing cold intolerance, constipation, fatigue, and weight gain. These hypometabolic features, along with bradycardia, are what the nurse expects when assessing a client with an underactive thyroid. Option b is incorrect because heat intolerance and diarrhea reflect the sped-up metabolism of hyperthyroidism. They are the opposite of the sluggish processes in hypothyroidism, so these findings indicate the contrasting thyroid disorder rather than this one. Option c is incorrect because weight loss with a larger appetite is typical of hyperthyroidism, where metabolism races. A client with an underactive thyroid tends to gain weight instead, so this finding points to the opposite condition. Option d is incorrect because tachycardia and nervousness belong to the hypermetabolic state of hyperthyroidism. Hypothyroidism slows the heart and dulls activity, so these excitable findings do not fit the client described in the scenario.

Correct Answer: Take it on an empty stomach

Levothyroxine is taken on an empty stomach before breakfast for reliable and consistent absorption. Because the medication is lifelong and titrated by TSH, consistent morning dosing keeps the thyroid replacement at a steady level. Option a is incorrect because taking the drug at bedtime with a snack lets food interfere with absorption and disrupts the recommended morning routine. The empty-stomach timing before breakfast is what ensures the dose is absorbed properly, so this instruction is incorrect. Option b is incorrect because thyroid replacement is lifelong, so stopping it when symptoms ease allows the deficiency to return. The client must continue the medication and follow TSH levels, making discontinuation an unsafe and inaccurate instruction. Option c is incorrect because fiber reduces levothyroxine absorption, so taking it with a fiber supplement lowers the drug's effect. The medication should be separated from fiber, calcium, and iron, so pairing it with fiber works again

Correct Answer: Hand tremors

Hand tremors, tachycardia, and weight loss suggest the levothyroxine dose is too high, mimicking hyperthyroidism. Recognizing these signs of overreplacement tells the nurse the dose may need to be reduced to avoid coronary strain. Option a is incorrect because slowed speech reflects continued hypothyroidism, suggesting the dose is too low rather than too high. This finding would call for an increase in levothyroxine, so it points away from the overreplacement the question targets. Option c is incorrect because pallor is consistent with an underactive thyroid that remains undertreated, indicating a possible need to raise the dose. It signals insufficient hormone rather than excess, so it does not warrant decreasing the medication. Option d is incorrect because bradycardia is a feature of ongoing hypothyroidism and suggests the replacement is inadequate. A slow heart rate points toward increasing the dose, the opposite of the reduction indicated by hyperthyroid signs like tremors.