ATI RN
Provide Basic Patient Care Following Direction of Nursing Staff Questions
Question 1 of 5
The nurse has completed a preoperative assessment for a patient going to surgery and gathers assessment data. Which will be the most important next step for the nurse to take?
Correct Answer: A
Rationale: The correct answer is A because notifying the operating suite of the patient's latex allergy is crucial to prevent potential allergic reactions during surgery. This step ensures patient safety and proper care. Option B is irrelevant to the patient's immediate preoperative care. Option C is important but not the most critical at this moment. Option D is not appropriate as vital signs should be obtained by the nurse herself.
Question 2 of 5
You are ordered to administer 3 mg/min of lidocaine via intravenous infusion to your cardiac patient who presents with a heart rate greater than 130 beats per minute as well as greater than 10 multifocal PVCs every minute. Therefore, you quickly but carefully mix 2 grams of the medication in 500 mL of normal saline and attach micro-drip tubing to the solution bag. Which of the following drip rates would effectively deliver the ordered dose of lidocaine?
Correct Answer: B
Rationale: The correct answer is B: 30 gtts/min. To calculate the drip rate for an IV infusion, you need to use the formula: (Volume to be infused in mL) x (Drop factor of the tubing) / (Time in minutes). In this case, the volume to be infused is 500 mL, the drop factor is 60 gtt/mL (for micro-drip tubing), and the time is 1 minute. Therefore, (500 mL) x (60 gtt/mL) / (1 minute) = 30 gtts/min. This drip rate will effectively deliver the ordered dose of lidocaine at 3 mg/min. Choice A: 15 gtts/min is incorrect because it would deliver half of the ordered dose. Choice C: 60 gtts/min is incorrect because it would deliver double the ordered dose. Choice D: 45 gtts/min is incorrect because it does not match the calculated value for the required dose of 30 gt
Question 3 of 5
Which of the following is not a cause of shock?
Correct Answer: C
Rationale: The correct answer is C: Increased systemic vascular resistance. In shock, the body's response is to decrease vascular resistance to maintain tissue perfusion. Increased resistance would hinder blood flow, worsening oxygen delivery. Choices A, B, and D are causes of shock: A due to inadequate oxygen delivery, B due to decreased blood flow, and D due to insufficient cardiac output. By process of elimination, C is the correct answer as it goes against the body's compensatory mechanisms in shock.
Question 4 of 5
Which abnormal respiratory pattern is associated with structural or compressive lesions in the medullary respiratory center characterized by an irregular, cluster-type respiratory pattern?
Correct Answer: D
Rationale: The correct answer is D: Ataxic respiratory pattern. This abnormal pattern is characterized by irregular, unpredictable breathing with random pauses and clusters of breaths. It is associated with structural lesions in the medullary respiratory center. Agonal pattern (A) is seen in dying patients. Cheyne-Stokes (B) is characterized by periods of deep breathing followed by apnea, seen in conditions like heart failure. Biot's pattern (C) features irregular breathing with varying depth and rate, seen in increased intracranial pressure or brain injury. Therefore, the irregular, cluster-type breathing seen in ataxic pattern best matches the description provided.
Question 5 of 5
You are assessing an adult patient experiencing sudden-onset chest pain and dyspnea. He quickly exhibits jugular vein distension and cool, clammy skin. His trachea is midline, but there are palpable air pockets under the skin on his upper chest on the left side that feel as though they pop or vanish when you palpate them. What is this abnormal finding?
Correct Answer: A
Rationale: The correct answer is A: Subcutaneous emphysema. This finding is indicative of air trapped under the skin, leading to palpable air pockets that pop or vanish upon palpation. This occurs commonly in the context of chest trauma or underlying lung pathology. Jugular vein distension, cool, clammy skin, and chest pain with dyspnea are consistent with a possible pulmonary embolism or tension pneumothorax, both of which can lead to subcutaneous emphysema. Atelectasis (B) is the collapse of alveoli, not associated with palpable air pockets. Pitting edema (C) is fluid accumulation in the tissues, not related to air. Ascites (D) is fluid accumulation in the peritoneal cavity, not presenting as palpable air pockets.