ATI RN
ATI Nurs285 Med Surg Exam Questions
Extract:
Question 1 of 5
A nurse is auscultating the breath sounds of a client who has asthma. When the client exhales, the nurse hears continuous high-pitched squeaking sounds. The nurse should document this as which of the following adventitious breath sounds?
Correct Answer: B
Rationale: Wheezes are high-pitched, continuous sounds heard primarily during expiration due to narrowed airways, characteristic of asthma. Rhonchi are low-pitched, stridor is inspiratory, and crackles are discontinuous.
Question 2 of 5
A nurse is preparing to infuse 1 liter of 0.9% sodium chloride IV over 8 hr with a tubing set that delivers 15 gtts/mL. The nurse should set the manual IV infusion to deliver how many drops/min?
Correct Answer: A
Rationale: Using the formula: (
Total volume in mL × Drop factor) /
Total infusion time in minutes = Drops/minute, we calculate (1000 mL × 15 gtts/mL) / 480 minutes = 31.25 gtts/minute, which rounds to 31 gtts/minute.
Question 3 of 5
The nurse is caring for a patient with a long history of chronic obstructive pulmonary disease (COPD) who develops cor pulmonale. The nurse should monitor the patient for which expected finding if heart failure is present?
Correct Answer: C
Rationale: Peripheral edema is a key sign of right-sided heart failure in cor pulmonale, resulting from fluid accumulation due to impaired cardiac pumping.
Question 4 of 5
A patient is admitted to the respiratory unit with flail chest. The nurse understands that a flail chest is:
Correct Answer: A
Rationale: Flail chest is characterized by multiple rib fractures creating a free-floating chest wall segment that moves paradoxically, impairing ventilation. Other options describe different conditions.
Question 5 of 5
A nurse is providing discharge teaching to a client who has a Plaster of Paris walking cast on his left lower leg. Which of the following instructions should the nurse include?
Correct Answer: D
Rationale: Numbness or pain in the toes may indicate impaired circulation or nerve compression, requiring immediate attention. A musty odor suggests infection, ice is not typically recommended, and the cast must be kept dry.