ATI RN
ATI Med Surg Exam 9 Questions
Extract:
Question 1 of 5
A client diagnosed with cholecystitis reports right upper quadrant pain that radiates to the right shoulder. Which of the following interventions are the priority for the nurse to implement?
Correct Answer: D
Rationale: Assessing the pain level is the priority intervention for a client with cholecystitis. Pain is the most common symptom and can indicate the severity and complications of the condition. The nurse should use a numeric or descriptive scale to assess pain and monitor changes in location, intensity, and duration.
Question 2 of 5
A nurse reviewing a client's chart reads that the client was observed having a complex partial seizure with automatisms of the face. What does the nurse understand this to mean?
Correct Answer: D
Rationale: Complex partial seizures involve focal brain activity with impaired awareness, and automatisms like lip-smacking are involuntary facial movements (
Choice
D). Losing bladder control is typical of generalized tonic-clonic seizures (
Choice
A). Fixed, dilated eyes are not specific to complex partial seizures (
Choice
B). Involuntary groaning is less characteristic than facial automatisms (
Choice
C).
Question 3 of 5
A client has just had surgery to create an ileostomy. The nurse assesses the client in the immediate postoperative period for which most frequent complication of this type of surgery?
Correct Answer: D
Rationale: Fluid and electrolyte imbalance is a common complication of ileostomy surgery because the colon, which is bypassed, is primarily responsible for absorbing fluids and electrolytes. This leads to increased loss through stool, potentially causing dehydration and imbalances in sodium and potassium.
Question 4 of 5
A nurse in the emergency department is caring for a client following an automobile crash in which the client was unrestrained and thrown from the vehicle. When assessing the client, the nurse observes clear fluid draining from the client's nose. Which of the following interventions should the nurse take?
Correct Answer: D
Rationale: Inserting sterile packing into the nares is the safest option to prevent infection if the fluid is cerebrospinal fluid (CSF), indicating a possible basilar skull fracture, while avoiding actions that could introduce bacteria.
Question 5 of 5
A nurse caring for a client with hepatitis is providing education to the client about portal hypertension. Which of the following will the nurse include in the teaching?
Correct Answer: A
Rationale: Increased pressure from portal hypertension causes abdominal swelling (ascites). It is not caused by heart overworking, and it worsens, not resolves, with cirrhosis.