ATI RN
ATI Medical Surgical Proctored Exam 2023 With NGN Questions and Correct Answers Questions
Extract:
Question 1 of 5
A nurse is caring for a client who has left-sided heart failure. Which of the following manifestations should the nurse expect?
Correct Answer: A
Rationale: The correct answer is A: Crackles. Left-sided heart failure causes fluid buildup in the lungs, leading to pulmonary congestion. Crackles are indicative of fluid in the alveoli, a common sign of pulmonary edema in heart failure. Decreased urine output (
B), daytime oliguria (
C), and halo vision (
D) are not specific to left-sided heart failure. Decreased urine output and oliguria are more associated with kidney dysfunction, while halo vision is related to eye conditions like cataracts.
Question 2 of 5
A nurse is caring for a client who requires protective isolation following a hematopoietic stem cell transplant. Which of the following interventions should the nurse implement to protect the client from infection?
Correct Answer: A
Rationale:
Correct Answer: A
Rationale:
1. Positive pressure airflow in the client's room helps prevent airborne contaminants from entering, reducing the risk of infection.
2. This intervention creates a controlled environment suitable for clients with compromised immune systems.
3. The positive pressure airflow system pushes air out of the room, minimizing the risk of external pathogens entering.
4. This measure is crucial in protective isolation to protect the client from infections during the vulnerable post-transplant period.
Summary:
-
Choice B is not directly related to infection prevention in protective isolation.
-
Choice C is important for respiratory infections but is not a primary intervention for protective isolation.
-
Choice D is relevant but does not directly address infection prevention measures in protective isolation.
Question 3 of 5
A nurse is planning care for a client who has a new diagnosis of acute pancreatitis. Which of the following interventions should the nurse include in the plan of care?
Correct Answer: B
Rationale: The correct answer is B: Maintain the client on NPO status. In acute pancreatitis, the pancreas is inflamed, leading to digestive enzyme release and potential autodigestion of pancreatic tissue. Keeping the client NPO (nothing by mouth) helps rest the pancreas by reducing stimulation of enzyme secretion. This allows the pancreas to heal and decreases the risk of further complications. Administering antihypertensive medications (
A) is not typically a priority for acute pancreatitis. Placing the client in a supine position (
C) may not directly impact the pancreatitis. Monitoring for hypercalcemia (
D) is important in chronic pancreatitis but not typically a primary intervention in the acute phase.
Question 4 of 5
A nurse is planning care for a client who has *Clostridium difficile* gastroenteritis. Which of the following is an appropriate nursing action?
Correct Answer: C
Rationale: The correct answer is C: Obtain a stool specimen with gloves. This is important because *Clostridium difficile* is a highly contagious bacterium that spreads through fecal-oral route. By obtaining a stool specimen with gloves, the nurse can prevent the spread of the infection to themselves and others. Placing the client in a protective environment (choice
A) is not necessary as standard precautions are sufficient. Cleaning surfaces with chlorhexidine (choice
B) is important, but obtaining a stool specimen is a higher priority. Washing hands with alcohol-based hand rub (choice
D) is important, but gloves should be used when handling stool specimens for extra protection.
Question 5 of 5
A nurse is caring for a client who has cervical cancer and is receiving internal radiation therapy. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct action for the nurse to take is to check if the radioactive device is in the correct position. This is crucial to ensure that the radiation therapy is being delivered accurately and effectively. By verifying the position of the radioactive device, the nurse can prevent potential harm to the client and ensure the success of the treatment.
Choice B is incorrect because limiting visitors' time does not directly relate to the safety and effectiveness of the radiation therapy.
Choice C is incorrect as asking visitors to remain 3 feet away does not address the primary concern of verifying the device's position.
Choice D is also incorrect as lead-lined aprons are typically used by healthcare providers during procedures, not by the client.