ATI RN
ATI Custom MS Nurse Questions
Extract:
Client in halo traction to immobilize cervical spine
Question 1 of 5
A nurse is caring for a client who has been placed in halo traction to immobilize his cervical spine. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: Elevating the head of the bed can help improve the patient's comfort and reduce the risk of complications such as aspiration in a client with halo traction.
Extract:
Client with a spinal cord injury at T-4
Question 2 of 5
A nurse is caring for a client who has a spinal cord injury at T-4. The nurse should recognize that the client is at risk for autonomic dysreflexia. Which of the following interventions should the nurse take to prevent autonomic dysreflexia?
Correct Answer: C
Rationale:
To prevent autonomic dysreflexia, the nurse should take the intervention of preventing bladder distention. Autonomic dysreflexia is a serious medical problem that can happen if a person has injured the spinal cord in their upper back. It makes their blood pressure dangerously high and can lead to a stroke, seizure, or cardiac arrest.
Extract:
Client who had an open reduction internal fixation surgery
Question 3 of 5
A nurse is completing a neurovascular check for a client who had an open reduction internal fixation surgery. Which of the following findings should the nurse identify as possible manifestations of compartment syndrome?
Correct Answer: A,B,C
Rationale: The nurse should identify absence of pulse, altered sensation of the toes, and cool skin as possible manifestations of compartment syndrome. Compartment syndrome is a serious condition that can occur following surgery or injury, characterized by increased pressure within a muscle compartment that can lead to decreased blood flow and nerve damage.
Extract:
Client on the floor in the clonic phase of a tonic-clonic seizure
Question 4 of 5
A nurse enters a client's room and finds the client on the floor in the clonic phase of a tonic-clonic seizure. Which of the following interventions should the nurse take?
Correct Answer: D
Rationale: The nurse should place a pillow under the client's head if the client is on the floor in the clonic phase of a tonic-clonic seizure. This can help protect the client's head from injury during the seizure.
Extract:
Client with a cast on right leg
Question 5 of 5
While collecting data from a client who has a cast on his right leg, a nurse locates an area on the cast that feels warm to the touch. Which of the following findings should the nurse identify as a complication to the client's condition?
Correct Answer: B
Rationale: The nurse should identify infection as a complication to the client's condition. A warm area on the cast could indicate the presence of an underlying infection. The warmth could be due to an increase in blood flow to the area as the body tries to fight off the infection.