Questions 63

ATI RN

ATI RN Test Bank

ATI Med Surg Npro 2000 Exam Questions

Extract:


Question 1 of 5

A client diagnosed with major depressive disorder with psychotic features hears voices commanding self-harm. The client refuses to commit to developing a plan for safety. What should be the nurse's priority intervention at this time?

Correct Answer: C

Rationale: One-to-one observation ensures immediate safety for a client with active psychotic self-harm commands, preventing harm.

Question 2 of 5

The family of a client, stung by a bee, has rushed the client to the emergency room. The client is experiencing hives and redness at the site. Upon arrival, the client states, 'I feel a lump in my throat, and I am sweating. I can't breathe! I think I am going to die.' The nurse anticipates which emergency treatment next?

Correct Answer: B

Rationale: Epinephrine is the first-line treatment for anaphylaxis, rapidly reversing symptoms like throat swelling and breathing difficulty.

Question 3 of 5

A nurse is planning care for a 6-year-old child who has bacterial meningitis. Which of the following nursing interventions is unnecessary in the client's plan of care?

Correct Answer: D

Rationale: Measuring head circumference is unnecessary in a 6-year-old with fused skull bones, unlike in infants with meningitis.

Question 4 of 5

When caring for an unconscious client with increasing intracranial pressure, the nursing intervention that is contraindicated is:

Correct Answer: D

Rationale: Routine oropharyngeal suctioning can increase intracranial pressure by stimulating the vagus nerve, making it contraindicated.

Question 5 of 5

A nurse is reviewing the laboratory results of a client who has liver failure with ascites and is receiving spironolactone. Which of the following findings should the nurse expect?

Correct Answer: B

Rationale: Spironolactone, a potassium-sparing diuretic, causes hyponatremia by increasing sodium excretion.

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