ATI RN
ATI Med Surg Final Exam Nsg 232 Questions
Extract:
Question 1 of 5
A nurse is caring for a client on a mechanical ventilator receiving a neuromuscular blockade agent. The nurse should prioritize which action?
Correct Answer: B
Rationale: Reporting the absence of spontaneous respirations is critical as it may indicate inadequate ventilation requiring immediate intervention.
Question 2 of 5
A nurse is planning care for a client diagnosed with systemic scleroderma. The nurse recognizes that an appropriate nursing diagnosis for systemic scleroderma is altered tissue perfusion secondary to which of the following?
Correct Answer: C
Rationale: Raynaud's phenomenon causes vasospasm, leading to impaired tissue perfusion in systemic scleroderma.
Question 3 of 5
A nurse is caring for a client with a chest tube in place for treatment of a hemothorax. The nurse should prioritize which nursing intervention when caring for this client?
Correct Answer: D
Rationale: Coughing and deep breathing exercises promote lung expansion and prevent atelectasis, critical for recovery from hemothorax.
Question 4 of 5
A nurse is planning care for a client玸 with acute kidney injury. The nurse should recognize that which assessment data best supports the nursing diagnosis of Excess Fluid Volume?
Correct Answer: B
Rationale: Pitting edema is a direct sign of fluid overload, supporting the diagnosis of Excess Fluid Volume.
Question 5 of 5
A nurse is caring for a client two months following a total laryngectomy. The nurse should recognize that which of the following statements made by the client indicates the need for further teaching?
Correct Answer: A
Rationale: After a total laryngectomy, the sense of smell is significantly impaired or lost due to the inability to breathe through the nose, and this change is likely permanent.