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 quadriplegia from a spinal cord injury and reports having a severe headache. The nurse obtains a blood pressure reading of 210/108 mm Hg and suspects the client is experiencing autonomic dysreflexia. Which of the following actions should the nurse take first?
Correct Answer: D
Rationale: Placing the client in a high-Fowler's position reduces blood pressure in autonomic dysreflexia by promoting venous pooling.
Question 2 of 5
A nurse is evaluating the central venous pressure (CVP) of a client who has sustained multiple traumas. Which of the following interpretations of a low CVP should the nurse make?
Correct Answer: C
Rationale: Low CVP in trauma suggests hypovolemia from blood or fluid loss.
Question 3 of 5
A nurse is assessing a client who has a pneumothorax with a chest tube in place. For which of the following findings should the nurse notify the provider?
Correct Answer: D
Rationale: Tracheal deviation to the unaffected side indicates tension pneumothorax, a medical emergency.
Question 4 of 5
A nurse is monitoring a client who was admited with a severe burn injury and is receiving IV fluid resuscitation therapy. The nurse should identify a decrease in which of the following findings as an indication of adequate fluid replacement?
Correct Answer: B
Rationale: A decrease in heart rate indicates adequate fluid replacement, as tachycardia is a compensatory response to hypovolemia in burn patients.
Question 5 of 5
A nurse is preparing to administer an osmotic diuretic IV to a client with increased intracranial pressure. Which of the following should the nurse identify as the purpose of the medication?
Correct Answer: A
Rationale: Osmotic diuretics like mannitol reduce brain edema by drawing fluid into the bloodstream.