ATI RN
ATI n269 Med Surg Exam Questions
Extract:
Question 1 of 5
A nurse is caring for a client who has diabetic ketoacidosis. Which of the following manifestations should the nurse expect?
Correct Answer: B
Rationale: Acetone odor to breath is a hallmark sign of diabetic ketoacidosis. The body breaks down fats for energy, producing ketones, which are released in the breath, giving it a fruity or acetone-like odor.
Question 2 of 5
Which condition may be observed due to incorrect fluid replacement with hypotonic fluids in patients with diabetic ketoacidosis?
Correct Answer: A
Rationale: Cerebral edema is the most dangerous complication associated with the administration of hypotonic fluids in patients with diabetic ketoacidosis (DK
A). This occurs because hypotonic fluids cause rapid shifts in fluid and electrolytes, which can lead to swelling of the brain, especially in children. The risk is heightened if fluids are replaced too quickly.
Question 3 of 5
A nurse is caring for a client who is experiencing anaphylactic shock in response to the administration of penicillin. Which of the following medications should the nurse administer first?
Correct Answer: C
Rationale: Epinephrine is the first-line treatment for anaphylactic shock. It works by rapidly reversing the effects of anaphylaxis, such as bronchoconstriction, vasodilation, and edema, by stimulating alpha and beta receptors. Epinephrine should be administered as soon as anaphylaxis is suspected to stabilize the patient's condition.
Question 4 of 5
A nurse is auscultating the breath sounds of a client who has asthma. When the client exhales, the nurse hears continuous high-pitched squeaking sounds. The nurse should document this as which of the following adventitious breath sounds?
Correct Answer: A
Rationale: Wheezes are continuous, high-pitched musical sounds produced by the narrowing of airways, commonly heard in conditions like asthma. They occur mainly during exhalation and are indicative of airflow obstruction.
Question 5 of 5
A nurse in an emergency department is caring for a client who has diabetic ketoacidosis (DKA) and a blood glucose level of 925 mg/dL. The nurse should anticipate which of the following prescriptions from the provider?
Correct Answer: D
Rationale: 0.9% sodium chloride IV bolus is the first-line treatment for DKA to rehydrate the patient, correct electrolyte imbalances, and dilute the high blood glucose level. After stabilization, insulin therapy is also introduced.