ATI RN
ATI Medsurg Proctored Final Exam Questions
Extract:
Question 1 of 5
A nurse is caring for a client who has a three-chamber closed chest tube system. Which of the following actions should the nurse take after noticing a rise in the water seal chamber with client inspiration?
Correct Answer: A
Rationale: The correct answer is A. The rise in the water seal chamber with client inspiration indicates that the chest tube system is functioning properly. This rise is expected as the negative pressure in the pleural space increases during inspiration, causing the water level to momentarily increase. It is important for the nurse to understand this physiological response and continue to monitor the client for any signs of respiratory distress. Notifying the healthcare provider immediately or increasing suction level is unnecessary and may disrupt the client's respiratory status. Repositioning the client is not indicated in this situation.
Question 2 of 5
A nurse in an emergency room is caring for a client who sustained partial-thickness burns to both lower legs, chest, face, and both forearms. Which of the following is the priority action the nurse should take?
Correct Answer: A
Rationale: The correct answer is A: Inspect the mouth for signs of inhalation injuries. This is the priority action because inhalation injuries can be life-threatening and must be assessed immediately in burn patients. Burns to the face and chest increase the risk of inhalation injuries due to the proximity to the airway. Administering pain medication, placing the client on oxygen therapy, and starting an IV line are important interventions but inspecting the mouth for signs of inhalation injuries takes precedence in this situation to ensure the client's airway is not compromised.
Question 3 of 5
A nurse is caring for a client who is receiving cisplatin to treat bladder cancer. After several treatments, the client reports fatigue. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Check the results of the client's most recent CBC. Fatigue is a common side effect of cisplatin, which can cause bone marrow suppression leading to anemia. Checking the CBC will help determine if the client is experiencing anemia, which can be managed with appropriate interventions. Administering a blood transfusion (
B) should not be done without confirming the need through lab results. Offering a stimulant medication (
C) may mask the underlying cause of fatigue. Advising the client to reduce physical activity (
D) may not address the root cause of the fatigue.
Question 4 of 5
A nurse is teaching a client who has hypertension and a new prescription for atenolol. Which of the following findings should the nurse include as adverse effects of this medication?
Correct Answer: D
Rationale: The correct answer is D: Bradycardia. Atenolol is a beta-blocker that slows down the heart rate, leading to bradycardia as an adverse effect. This occurs because atenolol blocks the action of adrenaline on the heart, causing the heart to beat slower. Hyperglycemia (
A) is not a common adverse effect of atenolol; in fact, it may even lower blood sugar levels slightly. Tachycardia (
B) and hypertension (
C) are the opposite effects of atenolol, as it is used to treat high blood pressure and reduce heart rate.
Therefore, these would not be expected adverse effects.
Question 5 of 5
A nurse is admitting a client who has a serum calcium level of 12.3 mg/dL and initiates cardiac monitoring. Which of the following findings should the nurse expect during the initial assessment?
Correct Answer: A
Rationale: The correct answer is A: Lethargy. A serum calcium level of 12.3 mg/dL indicates hypercalcemia. In hypercalcemia, calcium affects the central nervous system, leading to lethargy, weakness, and confusion. Lethargy is a common early symptom of hypercalcemia. Hypertension is not typically associated with hypercalcemia. Muscle spasms are more common in hypocalcemia. Severe agitation is not a typical manifestation of hypercalcemia.