ATI RN
ATI Med Surg Nurs 224g Questions
Extract:
Question 1 of 5
A nurse is assessing a client who is 24 hours postoperative following an open reduction and internal fixation to repair a fracture of the femur. Which of the following assessment findings is an early manifestation of fat embolism syndrome (FES)?
Correct Answer: B
Rationale: Dyspnea, or difficulty breathing, is one of the earliest signs of FES due to fat globules obstructing pulmonary vessels.
Question 2 of 5
A nurse is planning care for a client who is to receive packed RBCs. The nurse should plan for the total infusion time to not exceed which of the following?
Correct Answer: D
Rationale: The standard practice is to complete the transfusion of packed RBCs within 4 hours to minimize the risk of bacterial growth and transfusion reactions.
Question 3 of 5
A nurse is assigned to care for a client diagnosed with autoimmune or idiopathic thrombocytopenic purpura (ITP). When reviewing the client's plan of care prior to caring for the client, the nurse should recognize that the priority concern in caring for the client is to monitor for:
Correct Answer: C
Rationale: Thrombocytopenia, or low platelet count, is the hallmark of ITP and the main concern for monitoring, as it increases the risk of bleeding and bruising.
Question 4 of 5
A nurse is caring for a client who has a spinal cord injury and is developing autonomic dysreflexia. Which of the following actions should the nurse take first?
Correct Answer: A
Rationale: Placing the client in a sitting position helps lower blood pressure by promoting venous return, addressing the hypertensive crisis first.
Question 5 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.