ATI RN
ATI Med Surg Exam 9 Questions
Extract:
Question 1 of 5
A client presents to the clinic with complaints of otalgia and muffled sounds. The client is diagnosed with external otitis. Which of the following will the nurse not include in client teaching?
Correct Answer: C
Rationale: Inserting a cotton-tip applicator to remove excess wax can damage the ear canal and increase infection risk, so it is not included in teaching (
Choice
C). Reporting bothersome itching indicates possible inflammation or infection, aiding monitoring (
Choice
A). Earplugs during swimming prevent water irritation of the ear canal (
Choice
B). Using a hairdryer on low, 6 inches away, helps dry the ear canal, reducing infection risk (
Choice
D).
Question 2 of 5
A client's chart indicates that they are legally blind. Which of the following is the definition of legally blind?
Correct Answer: B
Rationale: Legal blindness is defined as a best-corrected visual acuity of 20/200 or worse in the better eye. Full vision loss in one eye, inability to see from 200 feet without lenses, or 20/60 impairment do not meet this criterion.
Question 3 of 5
The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence?
Correct Answer: A
Rationale: Sweating and pallor are early signs and symptoms of dumping syndrome, which is a condition where food moves too quickly from the stomach to the small intestine, causing rapid fluid shifts and hormonal changes. Sweating and pallor are caused by hypoglycemia, which occurs when the high concentration of food in the small intestine stimulates insulin secretion. Abdominal cramping and pain are late signs and symptoms of dumping syndrome, which occur about one to three hours after eating. Abdominal cramping and pain are caused by intestinal distension, spasms, and gas formation. Double vision and chest pain are not signs and symptoms of dumping syndrome, but may indicate other serious conditions, such as stroke or heart attack. Double vision and chest pain should be reported to the provider immediately. Bradycardia and indigestion are not signs and symptoms of dumping syndrome, but may be related to other gastrointestinal disorders, such as gastritis or peptic ulcer disease. Bradycardia and indigestion should be evaluated by the provider for further diagnosis and treatment.
Question 4 of 5
A nurse is assessing a client who has meningitis. Which of the following findings should the nurse expect?
Correct Answer: C
Rationale: A throbbing headache is a common symptom of meningitis due to increased intracranial pressure and meningeal irritation. Inability to read suggests a stroke or brain tumor, bruising around the eyes suggests a skull fracture, and a heart rate of 50 suggests bradycardia, none of which are typical for meningitis.
Question 5 of 5
A nurse caring for a client with acute peritonitis reviews the physician's orders. The orders include an NPO diet, insertion of a nasogastric tube set to low intermittent suction, and IV fluids at 50 mL per hour. When asked why he will need the NG tube, what is the nurse's best reply?
Correct Answer: D
Rationale: Reason: This is incorrect because administering medications and electrolytes is not the primary purpose of inserting a nasogastric tube for a client with acute peritonitis. Medications and electrolytes can be given through other routes, such as IV or oral. Reason: This is incorrect because dilating the stomach as a presurgical preparation is not a relevant Reason for inserting a nasogastric tube for a client with acute peritonitis. Dilating the stomach may be done before some types of gastric surgery, but it does not apply to peritonitis. Reason: This is incorrect because stating that you will not be able to eat for several days is not an adequate explanation for inserting a nasogastric tube for a client with acute peritonitis. This statement does not address the rationale or the benefits of the procedure. It may also cause anxiety and resentment in the client. Reason: This is the correct choice because removing secretions and decompressing the stomach is the main Reason for inserting a nasogastric tube for a client with acute peritonitis. Peritonitis is an inflammation of the peritoneum, the membrane that lines the abdominal cavity. It can cause abdominal distension, pain, nausea, and vomiting. A nasogastric tube can suction out the gastric contents and reduce the pressure and irritation in the abdomen.