ATI RN
ATI Medical Surgical 2 Final 2024 Assessment Questions
Extract:
Question 1 of 5
A nurse is caring for a client who is postoperative following an open reduction internal fixation (ORIF) of a femur fracture. Which of the following parameters should the nurse include in the evaluation of the neurovascular status of the client's affected extremity?
Correct Answer: A,C,D
Rationale: Monitoring the temperature of the affected extremity is crucial in evaluating neurovascular status. A cool or cold extremity can indicate decreased perfusion, which may be a sign of neurovascular compromise. Assessing the color of the extremity is essential. Pallor or cyanosis can indicate poor blood flow or oxygenation, which are critical signs of neurovascular impairment. Evaluating sensation helps determine if there is any nerve damage or impairment. Changes in sensation, such as numbness or tingling, can indicate neurovascular compromise.
Question 2 of 5
A nurse in the emergency department is monitoring a client who has a cervical spinal cord injury from a fall. The nurse should monitor the client for which of the following complications? (Select all that apply.)
Correct Answer: B,C,E
Rationale: A weakened gag reflex, hypotension, and absence of bowel sounds are complications of a cervical spinal cord injury. Polyuria is not typically related, and hyperthermia is less common as a direct complication.
Question 3 of 5
A nurse is caring for a client who has a history of exposure to TB and symptoms of night sweats and hemoptysis. Which of the following tests should the nurse realize is the most reliable to confirm the diagnosis of active pulmonary TB?
Correct Answer: B
Rationale: A sputum culture for acid-fast bacillus is the gold standard for confirming active pulmonary TB, providing definitive diagnosis.
Question 4 of 5
A nurse is reviewing the laboratory report of a client's most recent Pap smear that indicates moderately abnormal cervical cells were present. Based on the description of the cells, which of the following changes of precancerous cell growth to the client's cervix should the nurse identify?
Correct Answer: D
Rationale: Dysplasia refers to the presence of abnormal cells within a tissue or organ, characterized by changes in cell size, shape, uniformity, arrangement, and structure. In the context of a Pap smear, dysplasia is indicative of precancerous changes.
Question 5 of 5
A nurse is caring for a male client who has chronic glomerulonephritis. Which of the following findings should the nurse expect?
Correct Answer: B
Rationale: Urine specific gravity is a measure of urine concentration. The normal range is typically from 1.005 to 1.030. A specific gravity of 1.035 indicates very concentrated urine, which could be due to dehydration or other factors, but it is not specifically indicative of chronic glomerulonephritis. Serum creatinine is a waste product from the normal breakdown of muscle tissue. Normal levels are approximately 0.6 to 1.2 mg/dL for males. A level of 7 mg/dL is significantly elevated and can indicate severe kidney dysfunction, which is consistent with chronic glomerulonephritis. This condition can lead to a decreased ability of the kidneys to filter waste, causing an accumulation of creatinine in the blood. Creatinine clearance is a test that measures how well creatinine is removed from the blood by the kidneys. The normal range is about 95 to 120 mL/min. A clearance of 120 mL/min is within the normal range and would not typically be expected in a client with chronic glomerulonephritis, as this condition usually results in reduced kidney function. Blood urea nitrogen (BUN) is another waste product filtered by the kidneys. Normal BUN levels are between 7 and 20 mg/dL. A BUN of 15 mg/dL is within the normal range and does not necessarily indicate kidney dysfunction from chronic glomerulonephritis.