ATI RN
ATI Nur 175 Med Surg Exam Questions
Extract:
Question 1 of 5
A nurse is caring for a client with a stroke and is scheduled for transfer to a rehabilitation center. Which of the following tasks are the responsibility of the nurse from the sending facility? (Select All that Apply)
Correct Answer: A,B,C,E
Rationale:
Choice A reason: Confirming that the rehabilitation center has a room available at the time of transfer is essential to ensure the client has a designated space upon arrival. This helps prevent any delays or complications during the transfer process.
Choice B reason: Ensuring the client has possession of his valuables is important for safeguarding the client's personal belongings during the transfer. This task helps prevent any loss or misplacement of valuable items.
Choice C reason: Completing a transfer form for the receiving facility is a critical task that involves documenting the client's medical information, treatment plan, and other relevant details. This form ensures that the receiving facility has all the necessary information to continue the client's care seamlessly.
Choice D reason: While assessing how the client tolerates the transfer is important, it is typically done after the transfer has occurred, rather than being a responsibility of the nurse at the sending facility. This task is more relevant to the receiving facility's staff.
Choice E reason: Sending a copy of the client's chart with diagnostic and laboratory results ensures that the receiving facility has access to the client's medical history, test results, and other pertinent information. This facilitates continuity of care and informed decision-making.
Question 2 of 5
The nurse is caring for a group of clients. After making initial rounds, which client is the nurse's priority?
Correct Answer: B
Rationale: This client, although admitted with a bowel obstruction, is currently demonstrating a steady gait while ambulating, suggesting that they are stable at the moment. This client is the priority because they have just received morphine, which requires close monitoring for potential adverse effects, such as respiratory depression. Morphine is a potent opioid, and its administration necessitates vigilant observation to ensure the client's safety. While the client with an infected wound and an elevated white blood cell count and temperature requires attention for infection management, the immediate risk of adverse effects from morphine administration takes precedence. This client, scheduled to begin physical therapy, is stable enough to participate in planned rehabilitation activities, making them a lower priority compared to the client who has just received a potent opioid.
Question 3 of 5
A nurse receives a shift report on the following clients. Which client should the nurse prioritize first?
Correct Answer: C
Rationale: A client who has undergone a cholecystectomy 2 days ago with decreased bowel sounds might be experiencing a common postoperative issue that requires monitoring but may not need immediate intervention. Decreased bowel sounds can result from the effects of anesthesia, pain medications, or the surgical procedure itself. While this condition warrants attention, it is not as urgent as new-onset confusion in another client. A client with diabetes mellitus and a blood glucose level of 140 mg/dL is within a manageable range, especially in a hospitalized setting. This level of blood glucose does not indicate immediate danger and can be managed with appropriate insulin or oral medication adjustments. It is important for maintaining overall glucose control, but it does not present an urgent situation requiring immediate prioritization over the other clients. A client with a left femur fracture experiencing new-onset confusion is the highest priority. New-onset confusion can be a sign of several serious conditions, such as delirium, infection, or a complication related to the fracture or its treatment. This symptom indicates an acute change in the client's condition that requires immediate assessment and intervention to determine the underlying cause and prevent further complications.
Therefore, this client should be prioritized first. A client admitted for dehydration with a blood pressure of 105/77 mm Hg has a relatively stable blood pressure reading. While dehydration requires prompt treatment with fluids, this client's condition is not as critical as the client experiencing new-onset confusion. The blood pressure reading indicates that the client is maintaining an adequate circulatory status and can be managed after addressing the more urgent needs of the client with confusion.
Question 4 of 5
The newly hired nurse educator for the emergency department is reviewing the hospital disaster plan and policies and finds that it has not been reviewed with the staff for 3 years. Which finding would be most important for the nurse educator to address related to the disaster plan?
Correct Answer: C
Rationale: Depleted stockpiles of medications and resuscitation equipment is a critical concern during a disaster, as it can directly impact the ability to provide care. However, this can typically be addressed by restocking and checking inventory regularly. It is not as immediately crucial as ensuring that all staff are trained and prepared to execute the disaster plan. Changes in hospital resources, such as personnel and infrastructure, can affect the execution of a disaster plan. While this is significant, the most pressing issue is ensuring that the new staff, who may be unfamiliar with the disaster protocols, are adequately trained and ready to respond effectively in an emergency. New staff lacking training and practice in using the disaster plan is the most important finding to address. In a disaster, the ability to implement the plan swiftly and effectively can save lives. Untrained staff may not know their roles, how to use equipment, or the procedures to follow, leading to chaos and ineffective response.
Therefore, it is crucial to ensure all staff are familiar with and have practiced the disaster plan. The risk of technologic disasters in surrounding communities is important to consider in the disaster plan. However, the immediate priority within the hospital is to ensure staff are trained and prepared to handle any disaster scenario. Without proper training, even the best-planned responses to technologic disasters may fail.
Question 5 of 5
A nurse is caring for a client who has returned to the unit following a surgical procedure. The client's oxygen saturation is 85%. Which of the following actions should the nurse take first?
Correct Answer: C
Rationale: Raising the head of the bed improves lung expansion and oxygenation, addressing low oxygen saturation first.