ATI RN
ATI Med Surg Nurs 224g Questions
Extract:
Question 1 of 5
A nurse is assessing a client who has diabetes mellitus and reports foot pain. The nurse should evaluate the client for which of the following alterations as indications that the client has an infection? (Select all that apply.)
Correct Answer: D,E
Rationale: Localized edema and an increase in neutrophils are signs of infection, indicating inflammation and immune response.
Question 2 of 5
A nurse is caring for a client who is unconscious and has a breathing pattern characterized by alternating periods of hyperventilation and apnea. The nurse should document that the client has which of the following respiratory alterations?
Correct Answer: D
Rationale: Cheyne-Stokes respirations are characterized by a cyclic pattern of increasing and decreasing tidal volumes followed by periods of apnea, fitting the description provided.
Question 3 of 5
A nurse is providing teaching to a client who has a family history of hypertension. The nurse should inform the client that his blood pressure of 124/79 mm Hg places him in which of the following categories?
Correct Answer: A
Rationale: A blood pressure of 124/79 mm Hg is considered elevated, with systolic readings from 120-129 and diastolic less than 80 mm Hg.
Question 4 of 5
A nurse is admitting a client with suspected appendicitis. Identify where the nurse will palpate to assess for pain at McBurney's point.
Correct Answer: A
Rationale: McBurney's point is located in the right lower quadrant of the abdomen, where tenderness is most likely to be maximal in cases of acute appendicitis.
Question 5 of 5
Ms. Jackson has been suffering from persistent vomiting for two days. She appears to be lethargic and weak and has myalgia. She is noted to have dry mucous membranes and her capillary refill time takes more than 4 seconds. She is diagnosed with gastroenteritis and dehydration. Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L. What acid base disorder is shown?
Correct Answer: D
Rationale: The elevated pH and HCO3 with a normal PaCO2 indicate metabolic alkalosis without respiratory compensation. Persistent vomiting can lead to loss of stomach acid, which causes metabolic alkalosis.