ATI RN Adult Med-Surg 2023

Extract:

Question 1 of 5

A nurse is caring for a client who has cervical cancer and is receiving brachytherapy. Which of the following actions should the nurse take?

Correct Answer: B

Rationale: Brachytherapy involves internal radiation; keeping visitors 6 feet away minimizes exposure.

Question 2 of 5

A nurse is caring for a client who is 3 hr postoperative following a total knee arthroplasty. Which of the following actions should the nurse take to prevent venous thromboembolism?

A. Keep the client's knees in a flexed position while they are in bed. B. Massage the client's legs every 4 hr while they are awake. C. Encourage the client to perform circumduction of the feet. D. Limit the client's fluid intake to 2,000 mL daily.

Correct Answer: C

Rationale: Foot circumduction promotes venous return, reducing thromboembolism risk.

Question 3 of 5

A client who is deaf and communicates using sign language is being admitted by a nurse who does not know sign language. Which of the following actions should the nurse take?

A. Obtain a board that uses colored pictures as communication. B. Request an interpreter during the initial assessment. C. Familiarize themselves with commonly used signed language. D. Ask a family member to be present during the admission.

Correct Answer: B

Rationale: An interpreter ensures accurate communication during the admission process.

Extract:

Nurses' Notes
Vital Signs
Laboratory Results
0900:

Client came to the emergency department this morning and reports not feeling well for the last 12 hr and increasing blood glucose. Client has a history of type 1 diabetes mellitus and hypertension. Client weight is 88 kg (194 lb). The client was recently treated for bronchitis and pneumonia. Client reports nausea and decreased appetite. Client is alert and orientated x 4, heart and lung sounds are clear. Client states that they have been frequently urinating and are extremely thirsty. Bowel sounds are hyperactive in all 4 quadrants. Bilateral pedal pulses 1+. Slight tenting of skin.

Peripheral IV established and labs drawn.

Question 4 of 5

A nurse is caring for a client in the emergency department. Which of the following provider prescriptions does the nurse anticipate?

A. Potassium chloride 20 mEq/L intravenous PRN potassium less than 5.0 mEq/L B. Initiate cardiac monitoring C. Regular insulin 20 units subcutaneously D. Regular insulin continuous intravenous infusion, titrate per diabetic ketoacidosis (DKA) protocol once potassium is greater than 3.3 mEq/L E. 0.9% sodium chloride at 15 ml/kg/hr for 1 hr and then reduce to 10 ml/kg/hr F. Dextrose 5% in water (DSW) intravenous at 5 ml/kg/hr for 4 hr G. Blood glucose checks every 4 hr

Correct Answer: D,E,

Rationale: DKA treatment includes insulin infusion, fluid resuscitation with saline, and monitoring urine output.

Extract:

Nurses' Notes
Vital Signs
Diagnostic Results
1000:

Client reports tightness in chest that radiates to left arm. States pain as 7 on a scale of 0 to 10. Started to feel nauseous after breakfast. Client states, "I had scrambled eggs and bacon like I do every morning." Client is diaphoretic and short of breath. Heart rate irregular and tachycardic. Alert and oriented to person, place, and time. Lungs clear to auscultation in all lobes. Bowel sounds are present in all 4 quadrants. +1 pedal pulses. Skin is cool to touch. Capillary refill less than 2 seconds.

Question 5 of 5

A nurse is admitting a client who reports tightness in their chest that radiates to left arm. The nurse is reviewing the client's medical record. Select the four findings that require immediate follow-up.

A. Blood glucose level B. Bowel sounds C. Blood pressure D. Pain level E. Electrocardiogram findings F. Lung sounds G. Troponin T level

Correct Answer: C,D,E,G

Rationale: Chest pain with radiation suggests a cardiac event; BP, pain, ECG, and troponin are critical.

ATI RN Adult Med-Surg 2023 | Nurselytic

Nurselytic

ATI RN

ATI RN