ATI RN
ATI Advanced Med Surg Exam 3 Questions
Extract:
Question 1 of 5
A nurse is caring for a client who is postoperative and whose respirations are shallow and 9/min. Which of the following acid-based imbalances should the nurse identify the client as being at risk for developing initially?
Correct Answer: B
Rationale: Shallow, slow respirations cause CO2 retention, leading to respiratory acidosis as the initial acid-base imbalance.
Question 2 of 5
An older patient with cardiogenic shock is cool and clammy. Hemodynamic monitoring indicates a high systemic vascular resistance (SVR). Which intervention should the nurse anticipate?
Correct Answer: B
Rationale: Sodium nitroprusside reduces high SVR, improving perfusion in cardiogenic shock with vasoconstriction.
Question 3 of 5
A nurse is caring for a client who is receiving positive-pressure mechanical ventilation. Which of the following interventions should the nurse implement to prevent complications? (Select all that apply.)
Correct Answer: B,D,E
Rationale: Daily verification of ventilator settings ensures safety, pantoprazole prevents stress ulcers, and elevating the head of the bed reduces ventilator-associated pneumonia risk.
Question 4 of 5
The nurse is caring for a patient receiving a continuous norepinephrine IV infusion. Which finding indicates that the infusion rate may need to be adjusted?
Correct Answer: C
Rationale: A MAP of 56 mm Hg indicates inadequate perfusion, suggesting the norepinephrine dose may need adjustment to maintain adequate blood pressure.
Extract:
Four hours after her arrival to the emergency department, the patient remains in second-degree type II heart block and her vital signs are stable. She is transferred to a telemetry unit to prepare for insertion of a permanent pacemaker later in the day. When she gets out of bed to use the restroom, she felt faint and had to sit on the floor. The nurse finds her sitting on the floor beside the commode; the patient is awake but somewhat confused. The nurse notes that the ECG monitor shows that the patient's heart rate is at 40 beats/minute and she is now in third degree heart block. The Rapid Response team is called, and preparations are made for the immediate application of a transcutaneous pacemaker (TCP).
Question 5 of 5
Which nursing actions should be included in the plan of care for the patient (Select All that Apply.)
Correct Answer: B,C,D,E,F
Rationale: Monitoring vital signs and ECG ensures stability, reassurance reduces anxiety, atropine may be used for bradycardia, proper pad placement ensures effective pacing, and analgesia addresses discomfort.