ATI RN
ATI RN Adult Medical Surgical 2023 Questions Correct Answers Questions
Extract:
Question 1 of 5
A nurse is caring for a client who has chronic venous insufficiency. Which of the following areas should the nurse assess for the presence of a venous ulcer?
Correct Answer: B
Rationale: The correct answer is B: Medial malleolus (ankle). Venous ulcers commonly occur in the lower legs, particularly around the medial malleolus due to poor circulation in chronic venous insufficiency. The pressure and pooling of blood in the veins can lead to tissue breakdown and ulcer formation in this area. Assessing the medial malleolus for the presence of a venous ulcer is crucial in managing the client's condition.
Incorrect
Choices:
A: Tip of the toes - Venous ulcers are less likely to occur in this area as it is more distal and less affected by venous insufficiency.
C: Ball of the foot - Venous ulcers are more commonly found in the lower legs rather than the ball of the foot.
D: Heel of the foot - While ulcers can develop on the heel, they are less likely to be venous ulcers in chronic venous insufficiency compared to the medial malleol
Question 2 of 5
A nurse is caring for a client who has tuberculosis. Which of the following precautions should the nurse implement for this client?
Correct Answer: B
Rationale: The correct answer is B: Airborne precautions. Tuberculosis is transmitted through the air via droplet nuclei. Implementing airborne precautions includes wearing an N95 respirator, placing the client in a negative pressure room, and ensuring proper ventilation. Standard precautions (
A) are for all clients, contact precautions (
C) are for direct contact with the client or their environment, and droplet precautions (
D) are for pathogens transmitted through respiratory droplets.
Therefore, implementing airborne precautions is crucial to prevent the spread of tuberculosis.
Question 3 of 5
A nurse is providing teaching to a client who has neutropenia and is receiving chemotherapy. Which of the following client statements indicates an understanding of the teaching?
Correct Answer: A, C
Rationale:
Correct
Answer: A, C
Rationale:
A: Avoiding crowds helps reduce the risk of exposure to infections, crucial for neutropenic clients.
C: Taking temperature daily allows early detection of fever, a sign of infection.
B: Weekly toothbrush washing does not directly impact infection risk.
D: Fresh fruits and vegetables are good for health but not specific to neutropenia management.
Question 4 of 5
A nurse is preparing to administer propranolol to several clients. For which of the following clients should the nurse clarify the prescription with the provider before administration?
Correct Answer: A
Rationale: The correct answer is A. Propranolol is a non-selective beta-blocker that can potentially worsen asthma symptoms by causing bronchoconstriction.
Therefore, for a client with a history of asthma, the nurse should clarify the prescription with the provider to avoid exacerbating respiratory issues. The other choices (B, C,
D) do not typically contraindicate propranolol administration, as it is commonly used to manage hypertension, migraines, and stable angina. It is important to consider individual client factors when administering medications to ensure safety and effectiveness.
Question 5 of 5
A nurse is monitoring a client who has a traumatic brain injury. Which of the following findings should the nurse identify as a manifestation of Cushing's triad?
Correct Answer: A
Rationale: The correct answer is A because Cushing's triad consists of hypertension, bradycardia, and irregular respirations. In a client with a traumatic brain injury, increased intracranial pressure can lead to Cushing's triad due to brainstem compression. Option A reflects an increase in blood pressure, which is a key component of Cushing's triad.
Choices B, C, and D do not align with the expected findings of Cushing's triad.
Choice B indicates a decrease in heart rate, which is contrary to the bradycardia seen in Cushing's triad.
Choice C mentions rapid respirations, whereas irregular or shallow respirations are more characteristic.
Choice E mentions hypotension, which is not part of Cushing's triad.
Therefore, option A is the correct choice as it aligns with the manifestation of hypertension in Cushing's triad.