ATI RN
ATI Advanced Med Surg Exam 4 Questions
Extract:
Question 1 of 5
A nurse is assisting with triaging clients following an explosion. Which of the following clients should the nurse identify as the highest priority?
Correct Answer: C
Rationale: Unconscious client with severe head injury and no respirations requires immediate intervention.
Question 2 of 5
A nurse is providing teaching to a client who has neutropenia. Which of the following information should the nurse include in the teaching?
Correct Answer: A
Rationale: Neutropenic clients must avoid crowds to minimize infection exposure.
Question 3 of 5
When requested to plan the response to the potential use of smallpox as a biological weapon, what should the emergency department (ED) nurse manager expect to obtain?
Correct Answer: D
Rationale: Vaccine is critical for smallpox prevention if administered early.
Question 4 of 5
A nurse is reviewing the laboratory results of a client who was admitted with a history of multiple myeloma. The nurse should expect to find an increase in which of the following laboratory values?
Correct Answer: C
Rationale: Bone breakdown in multiple myeloma releases calcium, increasing levels.
Extract:
Nurses' Notes
40-year-old client is 2 days post-op following a renal transplant. Client alert and oriented x3. Sitting in high Fowler's. Skin warm and dry. Client reports pain at incision site as 5 on a scale of 0 to 10. Incision approximated, sutures intact. No drainage noted. Heart sounds regular. Lung sounds diminished throughout. Instructed to use incentive spirometer. Abdomen soft and non-distended. Bowel sounds hypoactive x4. 1+ peripheral edema noted bilaterally. Foley catheter patent, urine pink tinged. Urine output in last hour 1500mL
Vital Signs
Temperature 37.7° C (99.8° F)
Heart rate 110/min
Respiration rate 24/min
BP 94/56 mm Hg
Oxygen saturation 96% on room air
Question 5 of 5
A nurse is caring for a 40-year-old client in a transplant unit. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
Action to Take
Potential Condition
Parameter to Monitor
Correct Answer: A, A, C, A, B
Rationale: Hypovolemia indicated by high urine output and low BP. Lower bed and IV bolus address hypovolemia; monitor urine output and BP.