ATI RN
ATI RN Adult Medical Surgical 2019 with NGN Questions
Extract:
Question 1 of 5
A nurse is assessing a client who has increased intracranial pressure (ICP). The nurse should recognize that which of the following is the first sign of deteriorating neurological status?
Correct Answer: C
Rationale: Altered level of consciousness is the earliest and most sensitive sign of increased ICP, detectable via the Glasgow Coma Scale. Pupillary dilation, decorticate posturing, and Cheyne-Stokes respirations are later signs indicating severe brainstem involvement.
Question 2 of 5
A nurse is assessing for early signs of compartment syndrome for a client who has a short-leg fiberglass cast. Which of the following findings should the nurse expect?
Correct Answer: A
Rationale: Intense pain with movement is an early sign of compartment syndrome due to increased pressure compromising tissue perfusion. Bounding pulses, erythema, and normal capillary refill are not typical early indicators.
Question 3 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.
Question 4 of 5
A nurse is providing discharge teaching for a client who has osteomyelitis in the left leg. Which of the following findings should the nurse identify as requiring a referral?
Correct Answer: B
Rationale: Long-term IV antibiotic therapy for osteomyelitis requires referral to prevent complications like peripheral thrombophlebitis. Elevated WBC is expected, furosemide is unrelated, and a HbA1c of 6% indicates good glycemic control.
Question 5 of 5
A nurse is caring for a client who has developed a heart rate of 38/min and reports tremors and feeling faint. Which of the following medications should the nurse anticipate administering?
Correct Answer: C
Rationale: Atropine sulfate treats symptomatic bradycardia (38/min) by increasing heart rate, addressing tremors and faintness. Other medications are inappropriate for this condition.