ATI RN
ATI Med Surg Custom N235 Final Summer 2023 Questions
Extract:
Question 1 of 5
A nurse is caring for a client who has hypovolemic shock. Which of the following should the nurse recognize as an expected finding?
Correct Answer: C
Rationale: Oliguria is expected in hypovolemic shock due to decreased renal perfusion.
Question 2 of 5
A nurse is caring for a client who has increased intracranial pressure. Which of the following interventions should the nurse take?
Correct Answer: D
Rationale: Elevating the head (typically 30°, but 20° here) reduces ICP by aiding venous drainage.
Question 3 of 5
A nurse in an emergency department is caring for a client who had a seizure and became unresponsive after stating she had a sudden, severe headache and vomiting. The client's vital signs are as follows: blood pressure of 198/110 mm Hg, pulse of 82/min, respirations of 24/min, and a temperature of 38.2°C (100.8°F). Which of the following neurologic disorders should the nurse suspect?
Correct Answer: D
Rationale: Sudden headache, seizure, and hypertension suggest a hemorrhagic stroke, likely from a ruptured vessel.
Question 4 of 5
A nurse in the emergency department is caring for a client who has an epidural hematoma following a motor-vehicle crash. Which of the following is an expected finding for this client?
Correct Answer: B
Rationale: Epidural hematomas often present with a lucid interval followed by unconsciousness due to rapid bleeding.
Question 5 of 5
A nurse in an emergency department is caring for an adult client who has burns on the front and back of both his legs and arms. Using the rule of nines, the nurse should document burns to which percentage of the client's total body surface area (TBSA)?
Correct Answer: A
Rationale: Rule of nines: each arm (18%) + each leg (18%) = 9% × 4 (front and back) = 54% TBSA.