ATI RN
ATI Nurs285 Med Surg Exam Questions
Extract:
Question 1 of 5
A client had a right-sided chest tube inserted two hours ago for pneumothorax. Which action should the nurse implement if there is no fluctuation in the water seal compartment?
Correct Answer: A
Rationale: Lack of fluctuation in the water seal compartment may indicate kinks, obstructions, or lung re-expansion. The nurse should first check the chest tube system for issues before escalating or adjusting suction.
Question 2 of 5
Postural drainage with percussion and vibration is ordered twice daily for a patient with chronic obstructive pulmonary disease (COPD). Which intervention should the nurse include in the plan of care?
Correct Answer: A
Rationale: Administering a bronchodilator before postural drainage opens airways, enhancing secretion clearance. Fluid restriction is inappropriate, deep breathing is secondary, and supine positioning is not ideal.
Question 3 of 5
A client suffered a fractured femur and is scheduled for surgery one day after sustaining the injury. The client develops acute respiratory distress syndrome (ARDS) and the healthcare provider suspects fat embolism (FES) based on which of the following clinical manifestations? (Select all that apply.)
Correct Answer: A,C,D
Rationale: Decreased PaO2 <60mmHg, decreased platelet count and hematocrit, and ECG changes (ST segment and T-wave) are clinical manifestations of fat embolism syndrome, indicating hypoxemia, DIC, and myocardial effects.
Question 4 of 5
Unlicensed assistive personnel (UAP) reports a client diagnosed with a fractured femur has 'fatty globules' floating in the urinal. Which intervention should the nurse implement first?
Correct Answer: C
Rationale: Assessing the client for dyspnea and altered mental status is the first priority because these are early indicators of fat embolism syndrome (FES), a serious complication of long bone fractures. Immediate assessment allows for early recognition and intervention to prevent further complications.
Question 5 of 5
A nurse is caring for an adolescent client whose right leg is in Buck's traction. Which of the following interventions should the nurse implement to promote the client's mobility?
Correct Answer: D
Rationale: Isometric exercises of both legs maintain muscle strength without disrupting traction, promoting mobility safely.