Questions 35

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ATI nur330 Med Surg Exam Questions

Extract:


Question 1 of 5

A nurse is caring for a client who develops a ventricular fibrillation rhythm. The client is unresponsive, pulseless, and apneic. Which of the following actions is the nurse's priority?

Correct Answer: B

Rationale: Defibrillation is the priority for ventricular fibrillation, a lethal arrhythmia, as early defibrillation increases survival chances. Epinephrine, airway management, and amiodarone are secondary actions.

Question 2 of 5

A nurse is caring for a client who has burns to his face, ears, and eyelids. The nurse should identify which of the following is the priority finding to report to the provider?

Correct Answer: C

Rationale: Difficulty swallowing may indicate airway edema, a life-threatening emergency requiring immediate attention. Low urinary output, pain, and tachycardia are important but secondary to airway concerns.

Question 3 of 5

A nurse is assessing a client who has a pleural effusion. Which of the following findings should the nurse expect?

Correct Answer: B

Rationale: Pleural effusion causes fluid accumulation in the pleural space, leading to dullness on percussion. Substernal retractions, crepitus, and crackles are not typical findings.

Question 4 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: B

Rationale: In mass casualty triage, clients with compromised respiration (>30 breaths/min) are prioritized as they may deteriorate quickly. Unconscious clients with absent respirations are considered unsalvageable in triage protocols.

Question 5 of 5

A patient with a TBI is experiencing increased Intracranial pressure. What position should the nurse place the patient?

Correct Answer: A

Rationale: Elevating the head to 30 degrees with neck midline facilitates venous drainage, reducing ICP. Other positions increase ICP by obstructing venous outflow or increasing cerebral blood flow.

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