ATI RN
ATI RN Adult Medical Surgical 2023 Questions Correct Answers Questions
Extract:
Question 1 of 5
A nurse is caring for a client who has acute heart failure and received morphine IV 30 min ago. Which of the following findings should the nurse identify as an indication that the medication was effective?
Correct Answer: A
Rationale: The correct answer is A: Decreased anxiety. Morphine is often used to relieve pain and anxiety in patients with acute heart failure. The nurse should expect a reduction in anxiety as a positive response to the medication. Emesis (choice
B) is not a typical indication of morphine effectiveness. Increased respiratory rate (choice
C) may indicate respiratory depression, a potential adverse effect of morphine. Decreased urinary output (choice
D) could suggest decreased cardiac output, which is not necessarily a sign of morphine effectiveness in this case.
Question 2 of 5
A nurse is monitoring an older adult client who has an exacerbation of chronic lymphocytic leukemi The nurse notes petechiae on the client's skin. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: The correct answer is C: Institute bleeding precautions. Petechiae are tiny red or purple spots on the skin caused by bleeding under the skin. In chronic lymphocytic leukemia, the client's platelet count may be low, leading to an increased risk of bleeding. By instituting bleeding precautions, the nurse can help prevent injuries that could result in further bleeding. Determining the client's blood type (
A) is not necessary in this situation. Avoiding IV pain medication (
B) is not directly related to managing petechiae. Implementing airborne precautions (
D) is not relevant to the client's presentation with petechiae.
Question 3 of 5
A nurse is caring for a client who has emphysema. Which of the following interventions should the nurse include in the client's plan of care?
Correct Answer: D
Rationale: The correct answer is D. Teaching the client a breathing exercise with a longer inhalation phase helps improve lung capacity and strengthen respiratory muscles, which are essential for clients with emphysema. This intervention can help the client breathe more effectively and reduce shortness of breath. Option A is incorrect because limiting fluid intake is not a standard intervention for emphysema. Option B is incorrect as administering oxygen is not specific to improving lung function. Option C is incorrect as incentive spirometry is more effective if done for longer durations.
Question 4 of 5
A nurse is caring for a client who is postoperative and develops respiratory depression after receiving morphine for pain control. Which of the following medications should the nurse expect the provider to prescribe?
Correct Answer: D
Rationale: The correct answer is D: Naloxone. Naloxone is an opioid antagonist that reverses the effects of opioids, including respiratory depression.
Therefore, the nurse should expect the provider to prescribe naloxone to counteract the respiratory depression caused by morphine. Flumazenil (
A) is a benzodiazepine antagonist and would not be effective in this situation. Calcium gluconate (
B) is used to treat calcium deficiencies and would not address respiratory depression. Diphenhydramine (
C) is an antihistamine and not indicated for reversing opioid-induced respiratory depression.
Question 5 of 5
A nurse is teaching a client who has left-sided weakness how to use a quad cane. Which of the following client actions indicates an understanding of the teaching?
Correct Answer: B
Rationale: The correct answer is B. Advancing the weaker leg forward to the cane provides stability and support, helping distribute weight evenly and preventing falls. This step is crucial in using a quad cane effectively. Moving the cane too far ahead (
A) could cause imbalance. Taking a step with the stronger leg first (
C) would not provide the needed support for the weaker side. Holding the cane with the same side as the weakness (
D) may not provide the necessary support. It is essential to prioritize stability and weight distribution, making option B the correct choice.