ATI LPN
Perioperative Nursing Care Test Questions Questions
Question 1 of 5
A nurse is monitoring a client after moderate sedation. The nurse documents the clients Ramsay Sedation Scale (RSS) score at 3. What action by the nurse is best?
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Question 2 of 5
The nurse is caring for a patient at risk for atelectasis. The nurse implements a first-line measure to prevent atelectasis development in the patient. What is an example of a first-line measure to minimize atelectasis?
Correct Answer: A
Rationale: Atelectasis, the collapse of alveoli, is prevented primarily by promoting lung expansion and airway clearance, making incentive spirometry a first-line measure. This device encourages deep breathing, increasing lung volume and reopening collapsed alveoli, especially in at-risk patients (e.g., postoperative, immobile). It empowers patients to actively improve ventilation, reducing mucus plugging and enhancing gas exchange. IPPB and PEEP, while effective, are advanced interventions requiring equipment and are used when first-line methods fail IPPB delivers pressure to inflate lungs, and PEEP maintains airway pressure in ventilated patients. Bronchoscopy removes obstructions but is invasive, reserved for severe cases. Incentive spirometry's simplicity, accessibility, and efficacy in stimulating natural breathing mechanics make it the nurse's go-to strategy, supported by evidence for preventing postoperative atelectasis and improving respiratory outcomes.
Question 3 of 5
A patient with thoracic trauma is admitted to the ICU. The nurse notes the patients chest and neck are swollen and there is a crackling sensation when palpated. The nurse consequently identifies the presence of subcutaneous emphysema. If this condition becomes severe and threatens airway patency, what intervention is indicated?
Correct Answer: B
Rationale: Subcutaneous emphysema air trapped in subcutaneous tissues, causing swelling and crepitus arises from thoracic trauma (e.g., pneumothorax, bronchial rupture). When severe, it can compress the trachea, threatening airway patency, necessitating a tracheostomy to bypass upper airway obstruction and ensure ventilation. A chest tube treats the underlying pneumothorax, relieving pleural air but not subcutaneous spread impacting the airway directly. Endotracheal intubation may fail if tracheal compression prevents tube passage, making it less effective in this scenario. A feeding tube is irrelevant to airway management. The nurse's anticipation of tracheostomy reflects its role in securing a patent airway when subcutaneous air from trauma escalates, a critical intervention supported by trauma care protocols for maintaining oxygenation.
Question 4 of 5
A nurse is evaluating the diagnostic study data of a patient with suspected cystic fibrosis (CF). Which of the following test results is associated with a diagnosis of cystic fibrosis?
Correct Answer: A
Rationale: Cystic fibrosis (CF) diagnosis relies on elevated sweat chloride concentration, typically >60 mmol/L, from a sweat test. CFTR gene mutations impair chloride transport, increasing salt in sweat glands a hallmark of CF alongside thick mucus in organs like lungs and pancreas. Proteinuria indicates kidney issues, unrelated to CF's ion channel defect. Positive phenylketonuria (PKU) reflects a metabolic disorder of phenylalanine, distinct from CF's respiratory-gastrointestinal focus. Lung biopsy malignancy suggests cancer, not CF, which causes bronchiectasis or infection, not tumors. The nurse's evaluation of high sweat chloride confirms CF's pathophysiology chloride retention driving viscous secretions guiding genetic testing (e.g., CFTR mutations) and management (e.g., airway clearance), critical for this lifelong condition's early intervention.
Question 5 of 5
A pediatric nurse practitioner is caring for a child who has just been diagnosed with asthma. The nurse has provided the parents with information that includes potential causative agents for an asthmatic reaction. What potential causative agent should the nurse describe?
Correct Answer: A
Rationale: Pets are a common causative agent for asthma reactions in children, triggering airway inflammation via allergens like dander, saliva, or fur proteins. In sensitized kids, this initiates an IgE-mediated response, causing bronchospasm, mucus production, and dyspnea core asthma features. Lack of sleep may worsen coping but doesn't directly provoke attacks. Psychosocial stress can exacerbate symptoms via neuroimmune pathways but isn't a primary trigger. Bacteria cause infections, potentially worsening asthma, but aren't typical allergens. The nurse's focus on pets backed by allergy studies educates parents to identify and mitigate triggers (e.g., pet-free zones), empowering proactive management in this child's new asthma diagnosis, per pediatric asthma guidelines.