ATI RN
ATI Nsg 234 Med Surg Exam Neurologyendocrine And Sensory Questions
Extract:
Question 1 of 5
A nurse is caring for a client who is demonstrating signs of increasing intracranial pressure (ICP). The nurse recognizes that which nursing actions are indicated to decrease ICP?
Correct Answer: A,C,D
Rationale: Elevating the head of the bed, maintaining a calm environment, and administering morphine sulfate help reduce ICP by facilitating venous drainage, minimizing stimulation, and controlling pain, respectively.
Question 2 of 5
A nurse is assessing a client who has hypothyroidism. The nurse should expect which of the following findings?
Correct Answer: D
Rationale: Lethargy is a classic symptom of hypothyroidism due to decreased metabolism, leading to fatigue and reduced energy levels, making it the expected finding.
Question 3 of 5
A nurse is caring for a client who is experiencing Cushing's Triad following a depressed skull fracture. In addition to administering appropriate medications, which of the following nursing interventions should the nurse prioritize for this client?
Correct Answer: D
Rationale: Monitoring ICP is crucial in this situation, as Cushing's Triad indicates a potential increase in ICP, and timely interventions can prevent further complications.
Question 4 of 5
A nurse is assessing a client with autonomic dysreflexia. The nurse correlates which clinical manifestations to autonomic dysreflexia in a client with a spinal cord injury?
Correct Answer: A
Rationale: Hypertension with bradycardia is characteristic of autonomic dysreflexia due to the exaggerated sympathetic response causing increased blood pressure while the body compensates with bradycardia.
Question 5 of 5
A nurse is caring for a client 4 hours following surgical repair of a penetrating brain injury. Which of the following assessments should be the nurse's priority?
Correct Answer: C
Rationale: A neurological assessment is the priority to identify any changes in the client's condition that may indicate complications such as increased intracranial pressure, which can occur after brain surgery.