ATI RN
ATI Detailed Answer Key Medical Surgical Questions
Question 1 of 5
A client develops volume overload from an IV that has infused too rapidly. What assessment would the nurse expect to find?
Correct Answer: A
Rationale: An S3 heart sound indicates volume overload.
Question 2 of 5
A client with a chest tube connected to a closed drainage system needs to be transported to the x-ray department. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: The correct answer is C: Keep the drainage system below the level of the client's chest at all times. This is important to prevent backflow of air or fluid into the client's chest, which can lead to complications such as a pneumothorax or hemothorax. Gravity ensures that the drainage system functions properly and prevents any potential harm to the client. A: Clamping the chest tube prior to transferring the client is incorrect as it can cause a dangerous buildup of pressure in the chest. B: Disconnecting the chest tube from the drainage system can also lead to complications and disrupt the drainage process. D: Emptying the collection chamber is important but not the priority during transport; keeping the drainage system below the chest level is crucial for the client's safety.
Question 3 of 5
Mrs. Dailey tells the nurse that she uses eyedrops which make her pupils get small. Which of the following drugs would produce this effect?
Correct Answer: D
Rationale: Pilocarpine is a miotic agent that constricts the pupil, commonly used in treating glaucoma by improving aqueous humor outflow.
Question 4 of 5
A male client has returned to the Unit following a left femoral popliteal bypass graft. Six hours later, the client's dorsalis pedis pulse cannot be palpated and his foot is cool and dusky. The nurse should:
Correct Answer: B
Rationale: The client is losing the blood supply to his left foot. Continuing to monitor will not restore the blood supply to the foot. The physician should be notified immediately because the client is losing the blood supply to his left foot and is in danger of losing his foot and/or his leg. It is the responsibility of the nurse caring for the client to notify the physician, not the head nurse. This would be giving the client false assurances, which is unethical, demeaning, and could have legal consequences.
Question 5 of 5
Which indicates a person selected on the client’s behalf to make medical decisions when the client cannot?
Correct Answer: A
Rationale: A durable power of attorney for healthcare designates a proxy decision-maker, ensuring the client's wishes are honored.