ATI RN
ATI RN Adult Medical Surgical 2019 with NGN Questions
Extract:
Question 1 of 5
A nurse is administering packed RBCs to a client. The client reports chills, lower back pain, and nausea 10 min after the infusion begins. Which of the following actions should the nurse take first?
Correct Answer: D
Rationale: Chills, back pain, and nausea suggest a hemolytic transfusion reaction; stopping the infusion prevents further exposure to incompatible blood.
Question 2 of 5
A nurse is caring for a client who has been receiving total parenteral nutrition (TPN) for 1 week. For which of the following findings should the nurse notify the provider?
Correct Answer: B
Rationale: A calcium level of 11.5 mg/dL indicates hypercalcemia, a TPN complication that may require formula adjustment or diuretics. Other findings are within normal or expected ranges for TPN.
Question 3 of 5
A nurse is caring for a client who is receiving continuous bladder irrigation following a transurethral resection of the prostate (TURP). The client reports sharp lower abdominal pain. Which of the following actions should the nurse take first?
Correct Answer: B
Rationale: Sharp abdominal pain may indicate catheter obstruction; checking urine output assesses for clots or blockages, the most urgent concern post-TURP.
Question 4 of 5
A nurse is caring for a group of clients. The nurse should obtain a blood pressure reading using only the left extremity from which of the following clients?
Correct Answer: B
Rationale: Blood pressure measurement on an arm with an arteriovenous fistula risks damage; the left arm is used instead. PICC lines, weakness, or Bell's palsy do not contraindicate BP measurement.
Question 5 of 5
A nurse is reviewing the following ABG results for a postoperative client: pH 7.27, PaCO2 49 mm Hg, PaO2 65 mm Hg, HCO 22 mEq/L. The nurse should interpret the findings as which of the following imbalances?
Correct Answer: A
Rationale: Low pH (7.27) and high PaCO2 (49 mm Hg) with normal HCO3 indicate respiratory acidosis from hypoventilation retaining CO2.