ATI RN
ATI Capstone Adult Medical Surgical Assessment 2 Questions
Question 1 of 5
What should the nurse do if a patient experiences abdominal cramping during enema administration?
Correct Answer: A
Rationale: When a patient experiences abdominal cramping during enema administration, the nurse should lower the height of the solution container. This adjustment can help alleviate the cramping by reducing the speed and pressure of the solution entering the colon. Increasing the flow of the enema solution (
Choice
B) can exacerbate the cramping. Stopping the procedure and removing the tubing (
Choice
C) may be necessary in extreme cases but is not the initial step. Continuing the enema at a slower rate (
Choice
D) may not effectively address the cramping, making it less optimal than lowering the height of the solution container.
Question 2 of 5
What is an escharotomy and why is it performed?
Correct Answer: A
Rationale: An escharotomy is a surgical procedure involving an incision through the eschar (dead tissue) to relieve pressure in burn injuries. It is performed to improve circulation to the affected area, prevent further damage, and restore blood flow.
Choice B is incorrect because an escharotomy is not primarily focused on removing dead tissue but rather on relieving pressure.
Choice C is incorrect as it describes a procedure related to pulmonary issues, not burn injuries.
Choice D is incorrect because while pain relief may be a result of an escharotomy, it is not the primary purpose of the procedure.
Question 3 of 5
A nurse is planning care for a patient diagnosed with diabetes insipidus. What should be included in the care plan?
Correct Answer: A
Rationale: The correct answer is to monitor serum albumin levels. In patients with diabetes insipidus, monitoring serum albumin levels is essential to assess for dehydration and nutritional deficits.
Choices B, C, and D are not directly related to managing diabetes insipidus. Restricting protein intake, encouraging fluid intake, and teaching the patient to avoid alcohol are interventions that may be relevant for other medical conditions but are not specific to addressing the needs of a patient with diabetes insipidus.
Question 4 of 5
A client has a Transient Ischemic Attack (TIA). What should the nurse teach?
Correct Answer: A
Rationale: The correct answer is A: Avoid eating within 3 hours of bedtime. For a client with a Transient Ischemic Attack (TI
A), it is crucial to avoid eating within 3 hours of bedtime to reduce reflux that can worsen symptoms.
Choice B is incorrect because consuming liquids between meals is not specifically related to managing TIA.
Choice C is incorrect as eating large meals may not be recommended, especially if the client needs to watch their caloric intake.
Choice D is incorrect because avoiding liquids entirely can lead to dehydration and is not a standard recommendation for TIA management.
Question 5 of 5
What is a typical symptom of a hemorrhagic stroke in a patient?
Correct Answer: A
Rationale: A sudden, severe headache is a common symptom of a hemorrhagic stroke due to brain bleeding. This headache is often described as the worst headache of one's life. Gradual onset of numbness (choice
B) is more characteristic of an ischemic stroke, where a blood clot blocks an artery in the brain. Loss of consciousness (choice
C) can occur in severe cases of stroke but is not specific to hemorrhagic strokes. Loss of speech ability (choice
D) is more associated with ischemic strokes affecting language centers of the brain.