ATI RN
ATI Fundamentals Exam Special Unit ADN Questions
Extract:
Question 1 of 5
A nurse auscultates heart sounds. When the nurse hears S2, which valves is the nurse hearing close?
Correct Answer: D
Rationale: Aortic and Pulmonic: The second heart sound (S2) is produced by the closure of the aortic and pulmonic valves at the beginning of diastole. This marks the end of systole. Aortic and Mitral: The mitral valve is associated with the S1 sound, not S2. S2 occurs when the semilunar valves (aortic and pulmonic) close. Mitral and Pulmonic: The mitral valve closure is heard in S1, while the pulmonic valve closure is part of S2. However, the mitral valve is not involved in S2. Mitral and Tricuspid: The mitral and tricuspid valves close during S1, not S2. These valves are atrioventricular (AV) valves, not semilunar valves.
Question 2 of 5
The nurse is caring for a patient who has experienced a laparoscopic appendectomy. For which type of healing will the nurse focus the care plan?
Correct Answer: A
Rationale: Primary Intention: Primary intention healing occurs when surgical incisions are closed with sutures, staples, or adhesive strips. Since laparoscopic procedures involve small incisions that are closed immediately, this type of healing applies. Partial-thickness repair: Partial-thickness repair refers to wounds that involve only the epidermis and part of the dermis (e.g., abrasions, minor burns). Surgical incisions are full-thickness wounds, so this is not applicable. Secondary Intention: Secondary intention healing occurs when wounds heal from the inside out, typically seen in pressure ulcers, large open wounds, or infected wounds. Surgical wounds that are sutured do not heal by secondary intention. Tertiary Intention: Tertiary intention healing occurs when a wound is left open initially and later closed due to infection risk or delayed healing. Laparoscopic appendectomy wounds are closed immediately, making this choice incorrect.
Question 3 of 5
A nurse is calculating the total fluid intake for a client during a 4-hr period. The client consumes 1 cup of coffee, 4 oz of orange juice, 3 oz of water, 1 cup of flavored gelatin, 1 cup of tea, 5 oz of broth, and 3 oz of water. The nurse should record how many mL of intake on the client's record? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
Correct Answer: 1170
Rationale:
Step 1: Convert cups and ounces to mL (1 cup = 240 mL, 1 oz = 30 mL): Coffee: 1 cup = 240 mL; Orange juice: 4 oz × 30 mL = 120 mL; Water.ConcurrentHashMap (first): 3 oz × 30 mL = 90 mL; Flavored gelatin: 1 cup = 240 mL; Tea: 1 cup = 240 mL; Broth: 5 oz × 30 mL = 150 mL; Water (second): 3 oz × 30 mL = 90 mL.
Step 2: Add all the mL values together: 240 + 120 + 90 + 240 + 240 + 150 + 90 = 1,170 mL. Final Answer: 1,170 mL.
Question 4 of 5
A nurse is reviewing the electrocardiogram (ECG) results. Which portion of the conduction system does the nurse consider when evaluating the P wave?
Correct Answer: B
Rationale: SA Node: The SA (sinoatrial) node initiates electrical impulses and is responsible for atrial depolarization, which produces the P wave on an ECG. This makes it the correct answer. AV Node: The AV node is responsible for delaying electrical impulses before they pass to the ventricles, but it does not generate the P wave. It affects the PR interval rather than the P wave itself. Purkinje Fibers: The Purkinje fibers play a role in ventricular contraction (QRS complex), not in the formation of the P wave. Bundle of HIS: The Bundle of HIS transmits impulses to the ventricles and is involved in ventricular depolarization, not atrial activity. It is not responsible for the P wave.
Question 5 of 5
A nurse is administering nasal decongestant drops for a client. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: Tell the client to blow his/her nose gently before the instillation of the drops: Blowing the nose clears the nasal passages, allowing the medication to reach the mucosa effectively. Assist the client to a side-lying position: The correct position is head tilted backward (supine with neck hyperextended) or head tilted slightly to the side to ensure proper absorption. A side-lying position is not appropriate for nasal drops. Hold the dropper 2 cm (1 inch) above the nares: The dropper should be placed just inside the nostril without touching it to prevent contamination. Holding it too high may cause the drops to miss the nasal mucosa. Instruct the client to stay in the same position for 2 minutes: Remaining in position for at least 5 minutes allows the medication to be absorbed without draining out of the nasal cavity.