ATI RN
Free Medical Surgical Certification Practice Questions Questions
Question 1 of 5
After a thoracentesis, a healthcare provider assesses a client. Which assessment finding warrants immediate action?
Correct Answer: D
Rationale: The correct answer is D because tracheal deviation indicates a potential tension pneumothorax, a life-threatening emergency requiring immediate intervention. Tracheal deviation occurs when there is a significant shift in the mediastinum due to increased pressure in the pleural space. This can compromise respiratory function and lead to respiratory failure. Options A, B, and C are not as urgent as tracheal deviation. Pain at 5/10 is expected post-thoracentesis, a small amount of drainage is common, and a pulse oximetry reading of 93% on low oxygen is concerning but not immediately life-threatening.
Question 2 of 5
A client with dyspnea and difficulty climbing stairs is classified as having class III dyspnea. Which intervention should the nurse include in the client's plan of care?
Correct Answer: A
Rationale: The correct answer is A: Assistance with activities of daily living. Class III dyspnea signifies moderate exertion causing symptoms. Therefore, the client may need help with daily activities to conserve energy. Daily physical therapy (B) may be too strenuous. Oxygen therapy (C) may not be necessary at this point. Complete bedrest (D) can lead to deconditioning.
Question 3 of 5
When assessing a client with pneumonia, which clinical manifestation should the nurse expect to find?
Correct Answer: C
Rationale: The correct answer is C: Dullness on percussion. In pneumonia, the affected lung tissue becomes consolidated, leading to dullness on percussion due to decreased air movement. The rationale behind this is that consolidation causes the air-filled lung tissue to become filled with fluid and inflammatory cells, impairing normal sound transmission upon percussion. Incorrect choices: A: Fremitus - Increased tactile fremitus is typically found in pneumonia due to the denser lung tissue, making this choice incorrect. B: Hyperresonance - Hyperresonance is commonly found in conditions like emphysema with increased lung air volume, not in pneumonia. D: Decreased tactile fremitus - This is contradictory as pneumonia usually presents with increased tactile fremitus due to the consolidated lung tissue.
Question 4 of 5
A client with chronic obstructive pulmonary disease (COPD) is being taught by a nurse. What nutrition information should the nurse include in the teaching?
Correct Answer: D
Rationale: Correct Answer: D Rationale: 1. High-fiber foods promote gastric emptying, reducing the risk of bloating and discomfort in COPD patients. 2. COPD patients may experience decreased appetite, and high-fiber foods can provide necessary nutrients without overeating. 3. Increased fiber intake can aid in managing constipation, a common issue in patients with COPD due to decreased physical activity. Summary: A: Avoiding fluids before meals is not directly related to COPD management. B: Resting before meals may help with dyspnea but does not address nutritional needs. C: Consuming six small meals a day may not be necessary for all COPD patients and is not as crucial as promoting gastric emptying with high-fiber foods.
Question 5 of 5
A nurse assesses a client who has a mediastinal chest tube. Which symptoms require the nurse's immediate intervention? (Select ONE that does not apply)
Correct Answer: A
Rationale: The correct answer is A: Production of pink sputum. Pink sputum can indicate bleeding, which is a serious complication with a mediastinal chest tube. Immediate intervention is needed to prevent further complications. Tracheal deviation (B) can indicate tension pneumothorax, requiring immediate intervention. Pain at insertion site (C) may indicate infection or dislodgement, also needing prompt attention. Sudden onset of shortness of breath (D) can suggest a pneumothorax, which requires immediate intervention as well. However, the production of pink sputum is the most critical due to the potential for severe complications like hemorrhage.