ATI RN
ATI Nurs285 Med Surg Exam Questions
Extract:
Question 1 of 5
A client receiving low molecular weight heparin subcutaneously to prevent DVT following hip replacement surgery reports to the nurse that she observed small purple hemorrhagic areas on the right and left sides of the abdomen. Which action should the nurse implement?
Correct Answer: B
Rationale: Small hemorrhagic areas (ecchymosis) at injection sites are a common side effect of low molecular weight heparin and do not require immediate escalation.
Question 2 of 5
A nurse is preparing to infuse 1 liter of 0.9% sodium chloride IV over 8 hr with a tubing set that delivers 15 gtts/mL. The nurse should set the manual IV infusion to deliver how many drops/min?
Correct Answer: A
Rationale: Using the formula: (
Total volume in mL × Drop factor) /
Total infusion time in minutes = Drops/minute, we calculate (1000 mL × 15 gtts/mL) / 480 minutes = 31.25 gtts/minute, which rounds to 31 gtts/minute.
Question 3 of 5
Which assessment data would warrant immediate intervention by the nurse?
Correct Answer: C
Rationale: Pain on inspiration in a client with deep vein thrombosis may indicate a pulmonary embolism, a life-threatening condition requiring immediate assessment and intervention.
Question 4 of 5
A nurse is caring for a client who has multiple long bone fractures caused by a motor-vehicle crash that happened 24 hr ago. The client tells the nurse he is short of breath and experiencing chest pain. The nurse should assess the client further for which of the following potential complications?
Correct Answer: C
Rationale: Fat embolism syndrome is a serious complication of long bone fractures, presenting with respiratory distress and chest pain within 24-72 hours post-injury, matching the client's symptoms and timing.
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.