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2025 RN ATI ADULT MEDICAL-
SURGICAL PROCTORED EXAM (REAL
TEST BANK WITH NGN STYLE
QUESTIONS) – 100% VERIFIED
QUESTIONS AND ANSWERS | LATEST
UPDATED Q2-Q3 2025 | TRUSTED
NURSING STUDY GUIDE FOR EXAM
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Creatinine Clearance to Estimate GFR - << ANSWER IS>> -- Cockcroft-Gault equation: (140-age)x(ideal body wt)/72 x serum creatinine ~multiply by 0.85 if female
- Round SCr to 1 b/c if not = inaccurate reading Pharmacodynamic - << ANSWER IS>> --Branch of pharmacology concerned with the effects of drugs and the mechanism of their action.
- impaired homeostasis mechanisms (dec baroreceptor function & glucose regulation)
- changes in receptor affinity (dec response to B-blockers & B-agonists)
- reduced # of receptors (inc sensitivity to benzos, opioids, and anticoag); dizzy, alt mental status, dec resp Beers Criteria - << ANSWER IS>> --~Mark Beers MD, Geriatrician (1991) Identify inappropriate meds for use in nursing home residents in "common" situations that might be appropriate in specific circumstances (Benadryl)
- potentially (not definate) inappropriate, read rationale & recommendations, understand and approach accordingly, safer meds, ID & improve meds, should not be restricted, not = to all countries Polypharmacy - << ANSWER IS>> --Concomitant use of multiple drugs Use of more drugs than is clinically necessary (34% of all drugs prescribed in US are considered unnecessary) Factors: multiple diseases, sites of care, prescribers, patient driven prescribing, mult pharm, self med, fail to follow directions, confusion w/ mult med changes, inertia (dont rearrange deck chairs), prescribing cascade; drug 1->a.e. misinterpreted as a new clinical condition->drug 2 Evidence of Polypharmacy - << ANSWER IS>> --Meds w/ no apparent indication, duplicate/interacting meds, meds contraindicated in concurrent diseases or conditions, inappropriately high or low med doses Consequences of Polypharmacy - << ANSWER IS>> --#1 is adverse drug reactions(ADR): number of drugs is STRONGEST risk factor, relationship b/w # of drugs and likelihood of ADR, class of drug and underlying condition
- non-adherence
- financial burden
Transitions - << ANSWER IS>> --Focus on work, role of individual/spouse/partner
- speed and intensity of a major change can make diff b/w transitional crisis or gradual and comfortable adaption (ex. loss of child suddenly->takes more time to deal/cope & move on) Caregiving - << ANSWER IS>> --60% female, 82% care for one person, 85% care for relative, 59% assist w/ ADL (difficult), avg age of caregiver is 49yo
- Hispanics care for fam the most (less likely to put in nursing home) ~since care, 22% say own health has worsened (physical, emotional and financial strain) "Sandwich Generation": adults caring for children & parents Respite - << ANSWER IS>> --Short period of time when youre able to stop doing something that is difficult or unplesant or when it stops/delayed ~in health care; provides breaks from daily routine of caregiving. Relieves stress, restore energy and promote necessary balance in life (hours/days/weeks) Poorhouses - << ANSWER IS>> --Early 1900s; cared for the frail
- when elderly had no place to go, fam couldnt take care of them Social Security - << ANSWER IS>> --"age-entitlement" program (1935)
- amnt of benefit calculated on persons avg salary during 35 of their working years Supplemental Security Income: provides minimum level of economic support to ppl regardless of earning power in early
life or when capable of working (total support or supplements) ~pay portion of paycheck towards retirement; once retire claim $ as paycheck Other Income - << ANSWER IS>> ---private retirement or pension plans (401k)
- invested in private sector financial instruments (stocks, bonds) or gov treasury notes
- not all retirement plans include survivor benefits ~incoming $ will not go towards spouse Financing Health Care - << ANSWER IS>> --Medicare- health insurance (65yo) Railroad Medicare- "black lung insurance" (coal miners) Medicaid- poverty level services TRICARE- military/armed services Veterans Administration- older adults Medicare- Part A (1965) - << ANSWER IS>> --Person automatically receives this coverage when turn 65yo and paid Medicare taxes for at least 10yrs
- includes blind and totally disabled, and end-stage renal disease
- Hospital insurance plan covering acute care and acute & short-term rehab care and come costs assoc w/ hospice care and home health care under certain circumstances Medicare- Part B - << ANSWER IS>> --In 7 months surrounding 65th bday (from 3 months before), everyone is eligible for A must select and apply for this through local SS admin office
- covers visits w/ Dr., CRNP, outpt. services(labs), physical, speech & OT and some home health care providers
- Designed to help aged, blind, disabled people who have little/no income provides cash for basic need (single $735/mo, couples $1103/mo) Veterans Insurance - << ANSWER IS>> --Veterans Health Administration (VA) system has long help leadership position in gerontological, medical care and extended care
- ppl & their dependents who have been part of uniformed services may be eligible for healh care services thru VA hospital networks TRICARE for life: health care insurance prog provided by department of defense for eligible beneficiaries. Requires enrollment in both A and B & pay premiums for B.
- Medigap policy, TFL covers expenses not covered by Medicare (co-pays, prescription meds); what A&B doesnt cover ~can do both; veteran and health care Medicaid - << ANSWER IS>> - --have to apply/ poverty level services (low-income children, pregnant women, disabled, over 65yo); funded by federal & state gov using tax $ collected into general funds of each. (majority of funds are used to provide long-term nursing care) Long-term Care Insurance - << ANSWER IS>> --Cover expenses r/t co-pays for long-term care and coverage for custodial care or help w/ day-to-day needs (as apposed to skilled care)
- purchaser is cautioned to read policies about conditions and costs covered ~nursing home, PT (post-stroke), hospice; home care, need help w/ ADLs
What are the age-related changes in cardiovascular function? - << ANSWER IS>> --decreased beta-adrenergic responsiveness increased afterload decreased early diastolic filling increased dependency on atrial contraction prolonged relaxation time increased L ventricular end-diastolic pressure increased vascular tone True or False: Cardiac output can be maintained if heart rate or stroke volume are able to compensate for each other - << ANSWER IS>> --True True or False: Pulmonary system age-related changes are typically some of the first ones to be noticed - << ANSWER IS>> --False: they are slow and not noticed until the 60-80s What are the pulmonary system age-related FUNCTION changes? - << ANSWER IS>> --increased ventilation- perfusion mismatch decreased diffusion capacity increased physiological dead space decreased lung emptying decreased inspiratory muscle strength What are the pulmonary system age-related MEASUREMENT changes? - << ANSWER IS>> --increased residual volume and functional residual capacity decreased total lung capacity decreased max voluntary ventilation decreased vital capacity decreased forced expiratory volume decreased oxygen saturation
reduced exercise tolerance angina Angina - << ANSWER IS>> --chest pain due to a temporary oxygen supply/demand imbalance usually precedes an MI what are the 3 types of angina - << ANSWER IS>> --unstable - at rest, increases in severity, frequency, and duration and requires immediate attention stable - during activity, relieved by decreasing effort or nitroglycerin variant - caused by vasospasm of coronary arteries, short term relief with nitroglycerin What is the angina rating scale - << ANSWER IS>> -- 0 - no angina 1 - light, barely noticable 2 - moderate, bothersome 3 - more severe, very uncomfortable (pre-infarction pain) 4 - most severe or intense pain ever experienced (infarction pain) STEMI - << ANSWER IS>> --ST-segment Elevation Myocardial Infarction a severe type of heart attack characterized by a complete blockage of a coronary artery, leading to significant damage to the heart muscle NSTEMI - << ANSWER IS>> --non-ST-elevation myocardial infarction a type of heart attack where a portion of the heart muscle experiences reduced blood flow, leading to damage
angioplasty - implications for PT - << ANSWER IS>> --no strict guidelines but generally wait 2 weeks for aerobic exercise to allow for inflammation process Sternal Precautions - << ANSWER IS>> --no lifting/pulling/pushing >5lbs splint for cough/sneeze avoid pushing for STS, bed mobility, raising UE above 90 which type of heart failure will EF not be changed - << ANSWER IS>> --Diastolic BNP - << ANSWER IS>> -->500 typically indicates CHF EF - << ANSWER IS>> --normal 55-70% Digoxin - << ANSWER IS>> --increases contractility of the heart - used to treat heart failure decrease the workload of the heart to treat heart failure - << ANSWER IS>> --diuretics, vasodilators ACE inhibitors or ARB, vasodilators COPD stage - mild - << ANSWER IS>> --FEV/FVC <70% FEV1>80% predicted with/without cough, sputum production COPD stage - moderate - << ANSWER IS>> --FEV/FVC <70% 50% <FEV1<80% predicted SOB with exertion, with/without cough, sputum production COPD stage - severe - << ANSWER IS>> --FEV/FVC <70% 30% <FEV1 <50% predicted greater SOB with exertion, decreased exercise capacity, repeated exacerbations
change in cardiac rhythm CHF indicators to modify or terminate treatment - << ANSWER IS>> --marked dyspnea or fatigue RR> 40bpm development of S3 heart sound increase in crackles decrease in HR or BP >10mmHg during steadystate or progression diaphoresis, pale, confusion CVP increase by 10 mmHg Pursed lip breathing - << ANSWER IS>> --may delay or prevent airway collapse in for 2 out for 4 renal system age related changes - << ANSWER IS>> -- reduced bloodflow to the kidneys reduction of the number of nephrons increased urine volume hyponatremia common reduction of bladder capacity more urine production at night chronic kidney disease - << ANSWER IS>> --alteration of kidney function or structure for 3 or more months the 5 stages of CKD - << ANSWER IS>> --stage 1 - 90+ GFR stage 2 - 60 - 89 GFR stage 3 - 30 - 59 GFR stage 4 - 15 - 29 GFR stage 5 - <15 GFR
what symptoms are called uremia and when do they manifest
- << ANSWER IS>> --in stage 5 (ESRD) nausea, anorexia, pruritus, pericarditis, seizures, vomiting, lethargy, sensory and motor neuropathy, impaired heart function, asterixis what medication should be avoided by patients with CKD - << ANSWER IS>> --NSAIDs dialysis disequilibrium - << ANSWER IS>> --the result of rapid changes at the beginning of dialysis nausea, vomiting, drowsiness, headache, seizures dialysis dementia - << ANSWER IS>> --result of long-standing years of treatment when is exercise during dialysis most effective? - << ANSWER IS>> --low-moderate intensity during first 2 hours of hemodialysis still not considered the norm pharmacokinetics - << ANSWER IS>> --how the body processes a drug what are the principles of pharmacokinetics - << ANSWER IS>> --absorption, distribution, metabolism, elimination Pharmocodynamics - << ANSWER IS>> --what the drug does to the body absorption - << ANSWER IS>> --rate and extent that the drug leaves the administration site distribution - << ANSWER IS>> --extent the drug disperses in systemic circulation
how does the normal aging process affect drug excretion - << ANSWER IS>> --Decreased renal blood flow, decreased glomerular filtration rate, decreased tubular secretion. This can lead to increased half life and decreased drug clearance for renally excreted drugs ADRs - << ANSWER IS>> --noxious unintended reactions to drugs that occur at normal doses for drugs what are some common ADRs in older populations - << ANSWER IS>> --anticholinergic effects, confusion, constipation, dehydration, depression, dizziness, extrapyramidal signs, fatigue and weakness, GI upset, hypertension, hypocoagulation, postural hypotension, urinary incontinence, urinary retention what are anticholinergic activity effects and how do they affect older adults - << ANSWER IS>> --These block cholinergic responses (diaphoresis, GI motility, reduced CO), and causes delirium, drowsiness, blurred vision, tachycardia, dry mouth, urinary retention, constipation, and impaired diaphoretic response. the concept of prescribing cascades and how they affect older adults - << ANSWER IS>> --When a new drug is prescribed to address a side effect of another drug. This increases likelihood of adverse effects or cause new symptoms. It is better to adjust the original medication (either changing dose or switching to another drug). recommendations to improve drug related problems and medical errors in older adults - << ANSWER IS>> --Make a Medication profile including the drug name, strength, route, dose, frequency, status (when it was prescribed and changed), indication for taking it.
Blister packs to help with memory and prevent over or undertaking Have one provider be the one to prescribe the drugs Double check with a pharmacist if there are any issues All providers should check medication usage Reduce number of medications the patient is on if able Secreted by the hypothalamus and gastric glands of the stomach - << ANSWER IS>> --Somatostatin Somatostatin is released by_______ cells - << ANSWER IS>> -
- Delta Chronic hyperglycemia RT inadequate insulin secretion from the Pancreas or ineffective endogenous insulin - << ANSWER IS>> --Diabetes Mellitus DM is a disorder in_________ secretion,transportation and use of carbohydrate, protein and fat in__________ - << ANSWER IS>> --isulin, metabalism Glucose is stored as________ in the liver and muscle cells - << ANSWER IS>> --glycogen Excess breakdown of glycogen to glucose - << ANSWER IS>> --glycogenolysis defective glycolysis breaks glucose down into___________ - << ANSWER IS>> --lactic acid The formation of glycogen from amino acids that occurs in the liver - << ANSWER IS>> --Gluconeogensis Excessive fat breakdown - << ANSWER IS>> --lipolysis
Destruction of beta cells, thin at diagnosis, little or no endogenous insulin, ketosis prone, must have exogenous insulin to survive - << ANSWER IS>> --Type 1 Diabetes Obese, environmental cause, impaired insulin secretion, insulin resistance, may control with diet/excercise, oral antidiabetic drug (metformin), Ketosis uncommon - << ANSWER IS>> --Type 2 diabetes A1c 5.7%- 6.4%, fasting glucose 100- 125 - << ANSWER IS>> -- Prediabetes Secondary causes of DM - << ANSWER IS>> --pancreatitis and cushings Clinical symptoms of DM - << ANSWER IS>> --polyuria, polydipsia, polyphagia A1c of greater than or equal to 6.5%, FBG >126 - << ANSWER IS>> --DM 15 g of carbohydrates are equal to_____carb exchange - << ANSWER IS>> -- 1 Alcohol on empty stomach (DM) - << ANSWER IS>> --increase hypoglcemia have an osmotic effefct on the body - << ANSWER IS>> -- Sugar free foods (mannitol, sorbitol, xylitol, maltitol) Patients on_______ should eat 15 g of carbs before moderate exercise to prevent hypoglycemia - << ANSWER IS>> -- exogenous insulin
Should eat complex carbs/protein..... - << ANSWER IS>> --at end of exercise and bedtime Rapid acting inhaled insulin given beginning of meals - << ANSWER IS>> --Afrezza dimpling or pitting, raised hard tissue mass - << ANSWER IS>> --lipodystrophy SNS hunger, sweating, tremor, tachcardia, palpation, anxiety, headache, lightheaded, numbness of lips and tongue, impaired vision, lethargic - << ANSWER IS>> --hypoglycemia Inhibits hepatic glucose production - << ANSWER IS>> -- Alcohol What produces insulin? - << ANSWER IS>> --Beta Cells in pancreas Where is glucose stored? - << ANSWER IS>> --Liver and muscle cells What hormone stimulates the release of glycogen? - << ANSWER IS>> --Glucagon What is released by the delta cells? - << ANSWER IS>> -- Somatostatin Does somatostatin have a hypoglycemic effect? - << ANSWER IS>> --Yes, it interferes with the release of growth hormone from the pituitary gland and interferes with glucagon release from the pancrease
