ATI RN
ATI Med Surg Adult Care 2 Questions
Extract:
Question 1 of 5
A nurse at a community health clinic is caring for a client who reports a headache and stiff neck. Which of the following actions should the nurse take first?
Correct Answer: D
Rationale: Evaluating the client's neurological status is the first and most important action for this client, who has two classic signs of meningitis: headache and stiff neck.
Question 2 of 5
A nurse working on a medical unit is caring for a client who is prescribed seizure precautions. Which of the following interventions should the nurse Include in the client's plan of care?
Correct Answer: A
Rationale: Obtaining IV access is an important intervention for a client who is prescribed seizure precautions, as it allows for the administration of anticonvulsant medications and fluids in case of a seizure.
Question 3 of 5
A nurse suspects that a client admitted for treatment of bacterial meningitis is experiencing increased Intracranial pressure (ICP). Which of the following assessment findings by the nurse supports this suspicion?
Correct Answer: A
Rationale: A decrease in the Glasgow Coma Score indicates a deterioration in the level of consciousness, which is a sign of increased ICP.
Question 4 of 5
A nurse is creating a plan of care for a client who has a history of tonicclonic seizure disorder. Which of the following interventions should the nurse Include? (Select all that apply.)
Correct Answer: B,C,D,E
Rationale: Elevating side rails, placing the bed in the lowest position, providing suction, and keeping oxygen at the bedside are all appropriate interventions to ensure safety and manage potential complications during a seizure.
Question 5 of 5
A nurse collects health history from a 65 year old client. Which of the following risk factors in the client's history put chồng at the highest risk for embolic stroke?
Correct Answer: D
Rationale: Mitral valve replacement is the highest risk factor for embolic stroke among the choices given.