ATI RN
ATI RN Adult Medical Surgical 2023 III Questions
Extract:
Question 1 of 5
A nurse is caring for a client who has emphysema. Which of the following interventions should the nurse include in the client's plan of care?
Correct Answer: D
Rationale: Low-flow oxygen (e.g., 2 L/min) helps maintain adequate oxygenation in emphysema without suppressing the respiratory drive.
Extract:
Nurses' Notes
Day 1:
1000:
Client is alert to person, place, and time. Client is short of breath and leans forward to breathe easier. Lung sounds are diminished in bilateral bases with occasional wheezes. Nonproductive cough. Heart rate is regular. +2 pulses in all extremities.
1500:
Client is tachypneic, cough is productive, and mucous is yellow in color. Wheezes and crackles heard upon auscultation. Heart rate is regular. +2 pulses in all extremities. Client is oriented to person, place and time. Client is restless. Pupils are reactive to light. Client is diaphoretic with cyanotic mucous membranes
Vital Signs
1000:
Temperature: 37.1°C (98.8°F)
Heart Rate: 100/min
Respiratory Rate: 22/min (irregular)
Blood Pressure: 164/80 mm Hg
Oxygen Saturation: 92% on room air
1500:
Temperature: 37.3°C (100.3°F)
Heart Rate: 110/min
Respiratory Rate: 26/min (irregular)
Blood Pressure: 110/58 mm Hg
Oxygen Saturation: 87% on room air
Question 2 of 5
A nurse is caring for a client who has COPD. Select the findings below that require immediate follow-up.
Correct Answer: B,C,E,F
Rationale: Restlessness, tachypnea, yellow mucous, and wheezes/crackles indicate worsening COPD requiring intervention.
Extract:
Question 3 of 5
A nurse working in the emergency department is admitting a client who has pertussis. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: A surgical mask prevents droplet transmission of pertussis during close contact with the client.
Question 4 of 5
A nurse is planning care for a client who is postoperative following insertion of an arteriovenous graft in their left forearm. Which of the following actions should the nurse include in the plan of care?
Correct Answer: A
Rationale: Checking the distal pulse ensures adequate circulation and graft patency post-insertion.
Question 5 of 5
A nurse is preparing to administer intramuscular epinephrine to a client who is experiencing anaphylaxis. Which of the following sites should the nurse use?
Correct Answer: B
Rationale: The vastus lateralis is the preferred site for IM epinephrine due to its large muscle mass and rapid absorption.