ATI RN
ATI Adult Medical Surgical 2019 Questions
Extract:
Question 1 of 5
A nurse is caring for a client who is postoperative following a urinary diversion procedure to treat bladder cancer. Which of the following findings should indicate to the nurse that the client's stoma is functioning appropriately?
Correct Answer: A
Rationale: A red and moist stoma indicates healthy tissue and proper function. Soft and flat, pale and dry, or protruding 2 cm suggest complications like ischemia or obstruction.
Question 2 of 5
A nurse is caring for a client who has a traumatic brain injury. The client, who has been quiet and cooperative, becomes agitated and restless. Which of the following assessments should the nurse perform first?
Correct Answer: D
Rationale: Agitation and restlessness in traumatic brain injury may indicate increased intracranial pressure, often accompanied by elevated blood pressure, making it the first assessment.
Question 3 of 5
A nurse is monitoring an older adult client who has an exacerbation of chronic lymphocytic leukemia. The nurse notes petechiae on the client's skin. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: Petechiae indicate thrombocytopenia, requiring bleeding precautions like using soft toothbrushes. Airborne precautions, blood typing, and avoiding IV pain meds are not relevant.
Question 4 of 5
A nurse is monitoring a client who is receiving 2 units of packed RBCs. Which of the following manifestations indicates a hemolytic transfusion reaction?
Correct Answer: A
Rationale: Back pain is a specific early sign of a hemolytic transfusion reaction due to immune-mediated destruction of transfused RBCs. Bradycardia, hypertension, and chills are less specific.
Question 5 of 5
A nurse is caring for a client who has hypotension, cool and clammy skin, tachycardia, and tachypnea. In which of the following positions should the nurse place the client?
Correct Answer: C
Rationale: Elevating the feet improves blood flow to vital organs in hypovolemic shock. High-Fowler's, side-lying, and Reverse Trendelenburg do not address hypotension effectively.