ATI RN
ATI nur330 Med Surg Exam Questions
Extract:
Question 1 of 5
A nurse in an emergency department (ED) is admitting a client. Select the 3 findings that require immediate follow-up.
Correct Answer: A,C,E
Rationale: A heart rate of 43 bpm, third-degree AV block on EKG, and crackles with 90% oxygen saturation indicate life-threatening conditions requiring immediate intervention. Neurological status and temperature are stable.
Question 2 of 5
A nurse is assessing a client who develops respiratory distress, absence of breath sounds on one side, and deviation of the trachea away from the affected side. Based on these manifestations, which of the following conditions is the infant experiencing?
Correct Answer: D
Rationale: Tension pneumothorax causes respiratory distress, absent breath sounds, and tracheal deviation away from the affected side due to air accumulation in the pleural space. Flail chest, contusion, and fractured rib do not cause tracheal deviation.
Question 3 of 5
A nurse is conducting a primary survey of a client who has sustained life-threatening injuries due to a motor-vehicle crash. Identify the sequence of actions the nurse should take.
Correct Answer: C,D,E,B,A
Rationale: The ABCDE framework prioritizes airway (jaw-thrust), breathing (ventilatory assessment), circulation (IV access), disability (Glasgow Coma Scale), and exposure (remove clothing).
Question 4 of 5
A nurse is caring for a child who is having a seizure. Which of the following actions should the nurse take?
Correct Answer: A,C,D
Rationale: Side-lying position prevents aspiration, removing objects reduces injury risk, and assessing airway patency prevents hypoxia.
Tongue depressors and restraints are contraindicated.
Question 5 of 5
A nurse is caring for a client who came to the emergency department reporting chest pain. The provider suspects a myocardial infarction. While waiting for the troponin levels report, the client asks what this blood test will show. Which of the following explanations should the nurse provide the client?
Correct Answer: C
Rationale: Troponin is a heart muscle protein released into the bloodstream during myocardial injury, making it a specific marker for myocardial infarction. It is not a lipid, enzyme, or oxygen transporter.