ATI RN Adult Medical Surgical 2023 IV

Extract:

Question 1 of 5

A nurse is caring for a client who is experiencing a seizure. Which of the following actions should the nurse take first?

A. Clear items from the client's surrounding area.B. Loosen the client's restrictive clothingC. Obtain the client's vital signs.D. Lower the client to the floor.

Correct Answer: D

Rationale: Lowering the client to the floor (
D) prevents injury from falls during a seizure and is the priority. Clearing items (
A) and loosening clothing (
B) follow, while vital signs (
C) are not immediate during an active seizure.

Question 2 of 5

A nurse is assessing a client who has skeletal traction for a femoral fracture. The nurse notes that the weights are resting on the floor. Which of the following actions should the nurse take?

A. Remove one of the weights.B. Tie knots in the ropes near the pulleys to shorten them.C. Pull the client up in bed.D. Increase the elevation of the affected extremity.

Correct Answer: C

Rationale: Pulling the client up (
C) restores traction by lifting weights off the floor. Removing weights (
A), tying knots (
B), or elevating further (
D) disrupts traction alignment.

Question 3 of 5

A nurse in the emergency department is evaluating a young adult client for bacterial meningitis. Which of the following actions should the nurse take as part of the focused assessment?

A. Gently elevate the client's head and note any nuchal rigidity.B. Run a tongue blade on the outside of the client's sole and note any flaring of the toesC. Strike the client's patellar tendon with a percussion hammer and note any increase in response.D. Tap the client's facial nerve and note any facial twitching

Correct Answer: A

Rationale: Nuchal rigidity (
A) is a hallmark of meningitis due to meningeal irritation. Babinski's test (
B), patellar reflex (
C), and Chvostek's sign (
D) assess unrelated conditions.

Question 4 of 5

A nurse is providing discharge teaching for a client who is receiving treatment for genital herpes. Which of the following statements by the client indicates effectiveness of the teaching?

A. I should expect to take my medication for 3 weeks.B. I should apply antibiotic ointment to the lesions.C. I should expect my lesions to resolve in 6 weeks.D. I should use natural skin condoms during sexual intercourse.

Correct Answer: A

Rationale: Antiviral treatment for herpes (
A) typically lasts 7-10 days, but 3 weeks may reflect understanding of initial or suppressive therapy duration. Antibiotics (
B) are ineffective, lesions resolve in 2-4 weeks (
C), and natural condoms (
D) are less effective.

Question 5 of 5

A nurse is planning care for a client who has a seizure disorder. Which of the following equipment should the nurse place in the client's room?

A. NG tubeB. Wrist restraintsC. Oral airwayD. Tongue blade

Correct Answer: C

Rationale: An oral airway (
C) ensures airway patency during a seizure. NG tubes (
A) are unrelated, restraints (
B) are not routine, and tongue blades (
D) are unsafe.

ATI RN Adult Medical Surgical 2023 IV | Nurselytic

Nurselytic

ATI RN

ATI RN