ATI RN
ATI RN Adult Medical Surgical 2023 Questions Correct Answers Questions
Extract:
Question 1 of 5
A nurse is caring for a client who is experiencing diabetic ketoacidosis (DKA). Which of the following is the priority intervention by the nurse?
Correct Answer: D
Rationale: The correct answer is D: Administer 0.9% sodium chloride. The priority intervention in DKA is fluid resuscitation to correct dehydration and electrolyte imbalances. 0.9% sodium chloride helps restore intravascular volume and improves kidney perfusion. Checking potassium levels (
A) is important but can wait until after fluid resuscitation. Beginning bicarbonate infusion (
B) is not recommended as it can worsen acidosis. Initiating continuous IV insulin infusion (
C) is important but should follow fluid resuscitation. Administering 0.9% sodium chloride takes precedence in managing DKA.
Question 2 of 5
A nurse is caring for a client who had a lumbar laminectomy. Which of the following interventions should the nurse include in the plan of care?
Correct Answer: B
Rationale: The correct answer is B: Turn the client by log rolling with a turning sheet. After a lumbar laminectomy, it is essential to prevent twisting or bending at the waist to avoid damaging the surgical site. Log rolling with a turning sheet maintains proper alignment of the spine. Encouraging independent ambulation (
A) may put strain on the surgical area. Positioning in a high Fowler's position (
C) may increase pressure on the surgical site. Applying a heating pad (
D) can lead to increased inflammation and potential burns.
Extract:
Client reports tightness in chest radiating to the left arm. Pain level: 7/10. Feels nauseous after breakfast. Client states: 'I had scrambled eggs and bacon like I do every morning.' Symptoms: Diaphoresis, shortness of breath, irregular and tachycardic heart rate. Neurological Status: Alert and oriented to person, place, and time. Lung Sounds: Clear in all lobes. Bowel Sounds: Present in all 4 quadrants. Peripheral Circulation: +1 pedal pulses, skin cool to touch, capillary refill <2 seconds.
Question 3 of 5
Which actions should the nurse take? (Select all that apply)
Correct Answer: A, B, D,E
Rationale: The nurse should anticipate cardiac catheterization prep (
A) to ensure client readiness. Continuous heparin infusion (
B) prevents clot formation during the procedure. Increased metoprolol dosage (
D) may be needed for cardiac stability. NPO status (E) is crucial to prevent complications during the procedure. Ambulation (
C) may be contraindicated due to the invasive nature of the procedure. Antibiotics (F) are not routinely needed for cardiac catheterization prep.
Extract:
Question 4 of 5
A nurse is planning care for a client who has dementia and a history of wandering. Which of the following actions should the nurse plan to implement?
Correct Answer: C
Rationale: The correct answer is C: Use a bed alarm. This is the most appropriate action to help prevent the client from wandering and ensure their safety. A bed alarm will alert the nurse when the client tries to get out of bed, allowing for timely intervention. Moving the client to a double room (
A) may not necessarily prevent wandering. Using chemical restraints (
B) is not recommended due to ethical concerns and potential adverse effects. Encouraging excessive stimulation (
D) may increase agitation and wandering behavior.
Question 5 of 5
A nurse is caring for a client who has acute heart failure and received morphine IV 30 min ago. Which of the following findings should the nurse identify as an indication that the medication was effective?
Correct Answer: A
Rationale: The correct answer is A: Decreased anxiety. Morphine is often used to relieve pain and anxiety in patients with acute heart failure. The nurse should expect a reduction in anxiety as a positive response to the medication. Emesis (choice
B) is not a typical indication of morphine effectiveness. Increased respiratory rate (choice
C) may indicate respiratory depression, a potential adverse effect of morphine. Decreased urinary output (choice
D) could suggest decreased cardiac output, which is not necessarily a sign of morphine effectiveness in this case.