ATI LPN
PN Adult Medical Surgical 2020 Questions
Extract:
Question 1 of 5
A nurse is assisting with the care of a client who has a chest tube following thoracic surgery. Which of the following findings should the nurse recognize as an indication of a tension pneumothorax?
Correct Answer: A
Rationale: No bubbling in the water seal chamber may indicate lung collapse, signaling tension pneumothorax.
Question 2 of 5
A nurse is assisting with the care of a client who is receiving a blood transfusion. The client reports chills, back pain, and itching. Which of the following actions should the nurse take first?
Correct Answer: C
Rationale: Stopping the transfusion is the priority to halt a possible transfusion reaction.
Question 3 of 5
A nurse is preparing to administer ceftriaxone using the Z-track technique to a client who has gonorrhea. After the nurse performs hand hygiene and reconstitutes the medication, identify the sequence the nurse should use to administer the medication.
Correct Answer: D,B,E,A,C
Rationale: The Z-track sequence ensures safe administration: cleanse, pull skin, insert needle, aspirate/inject, remove needle/release skin.
Question 4 of 5
A nurse is caring for a client who has a closed head injury. Which of the following positions should the nurse place the client?
Correct Answer: C
Rationale: Semi-Fowler's position reduces intracranial pressure in head injuries.
Question 5 of 5
A nurse is reinforcing health promotion education at a community health fair. Which of the following statements by attendees indicates understanding of the teaching?
Correct Answer: C
Rationale: Breast exams a week after menstruation avoid hormonal swelling, ensuring accuracy.