ATI RN
ATI Detailed Answer Key Medical Surgical Questions
Question 1 of 5
A client with emphysema is being cared for by a nurse. Which of the following findings should the nurse not expect to assess in this client?
Correct Answer: B
Rationale: Step 1: Emphysema causes impaired gas exchange, leading to dyspnea (A) due to difficulty breathing. Step 2: Emphysema results in hyperinflation of the lungs, causing a barrel chest (C) due to increased chest diameter. Step 3: Clubbing of the fingers (D) is a sign of chronic hypoxia, commonly seen in emphysema. Step 4: Bradycardia (B) is not typically associated with emphysema; tachycardia is more common due to the body compensating for hypoxia.
Question 2 of 5
A client has a new diagnosis of myasthenia gravis. For which of the following manifestations should the nurse monitor?
Correct Answer: B
Rationale: The correct answer is B: Weakness. Myasthenia gravis is characterized by muscle weakness due to an autoimmune attack on neuromuscular junctions. Monitoring for weakness is essential to assess disease progression and response to treatment. Confusion (A) is not a typical manifestation of myasthenia gravis. Increased intracranial pressure (C) is more commonly associated with conditions like head trauma or brain tumors. Increased urinary output (D) is not directly related to myasthenia gravis and is more indicative of conditions affecting the kidneys or fluid balance.
Question 3 of 5
During an assessment, a client with a long history of smoking and suspected laryngeal cancer will most likely report which early manifestation?
Correct Answer: B
Rationale: The correct answer is B: Hoarseness. Hoarseness is a common early manifestation of laryngeal cancer due to vocal cord involvement. Smoking is a major risk factor for laryngeal cancer. Dysphagia (choice A) is more commonly associated with esophageal cancer. Dyspnea (choice C) is usually a late manifestation of laryngeal cancer when it causes airway obstruction. Weight loss (choice D) may occur later in the disease progression but is not typically an early sign. Thus, hoarseness is the most likely early manifestation due to its direct connection to the vocal cords and smoking history.
Question 4 of 5
While caring for a client with extensive partial and full-thickness burns of the head, neck, and chest, which risk should the nurse prioritize for assessment and intervention?
Correct Answer: A
Rationale: The correct answer is A: Airway obstruction. This should be prioritized because burns to the head, neck, and chest can lead to swelling and inflammation, potentially compromising the airway. Maintaining a clear airway is crucial for oxygenation and ventilation. If the airway becomes obstructed, it can quickly lead to respiratory distress or failure. Assessing for signs of airway compromise and intervening promptly is essential to prevent serious complications. Choices B, C, and D are incorrect because while infection, fluid imbalance, and paralytic ileus are also important considerations in burn care, they are not as immediately life-threatening as airway obstruction in this case. Infection can be managed with appropriate wound care, fluid imbalance can be addressed with fluid resuscitation, and paralytic ileus can be treated with medications and bowel management strategies.
Question 5 of 5
A client with chronic obstructive pulmonary disease (COPD tells the nurse, 'I can feel the congestion in my lungs, and I certainly cough a lot, but I can't seem to bring anything up.' Which of the following actions should the nurse take to help this client with tenacious bronchial secretions?
Correct Answer: D
Rationale: The correct answer is D: Encouraging the client to drink 2 to 3 L of water daily. Increased fluid intake helps to thin out bronchial secretions, making them easier to cough up. Step-by-step rationale: 1. Increased water intake promotes hydration, which thins mucus in the airways. 2. Thinner mucus is easier to expectorate, aiding in clearing airway congestion. 3. Adequate hydration also helps to prevent dehydration, which can further thicken secretions. Summary: A: Maintaining a semi-Fowler's position may help with breathing comfort but does not directly address the issue of thick secretions. B: Administering oxygen is important for COPD patients but does not specifically target bronchial secretions. C: Selecting a low-salt diet is beneficial for managing fluid retention but does not directly address the issue of tenacious bronchial secretions.