ATI RN
ATI Medsurg Proctored Final Exam Questions
Extract:
Question 1 of 5
A nurse is caring for a client with a sucking chest wound from a gunshot. What action should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Administer oxygen via nasal cannula. This is the priority action to ensure the client receives adequate oxygenation. In a sucking chest wound, air enters the pleural space, leading to a potential pneumothorax, which can compromise oxygenation. Administering oxygen helps maintain oxygen saturation levels and supports respiratory function. Placing the client in Trendelenburg position (choice
B) can worsen respiratory distress by increasing pressure on the diaphragm. Applying a warm compress (choice
C) may promote bleeding and is not effective in managing a sucking chest wound. Encouraging deep breathing exercises (choice
D) can further exacerbate the pneumothorax by allowing more air to enter the pleural space.
Question 2 of 5
A nurse is reviewing the arterial blood gas values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect?
Correct Answer: A
Rationale: The correct answer is A (pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg). In chronic kidney disease, the kidneys are unable to excrete acid effectively, leading to metabolic acidosis. The pH is low (acidotic) due to the accumulation of acids. The bicarbonate (HCO3-) is low (19 mEq/L) as the kidneys are unable to reabsorb and regenerate bicarbonate effectively. The PaCO2 is low (30 mm Hg) as the respiratory system compensates by increasing the respiratory rate to blow off carbon dioxide in an attempt to normalize the pH.
Choices B, C, and D have pH values within normal range and do not reflect the expected acidosis in chronic kidney disease.
Question 3 of 5
A nurse is preparing a client for radiation after a mastectomy. What adverse effect should be expected?
Correct Answer: C
Rationale: The correct answer is C: Fatigue. Radiation therapy often causes fatigue due to its impact on healthy cells surrounding the treatment area. This can result in decreased energy levels and overall tiredness. Alopecia (
A) is more commonly associated with chemotherapy. Diarrhea (
B) is a potential side effect of certain chemotherapy drugs or radiation to the abdominal area. Weight gain (
D) is not a typical adverse effect of radiation therapy.
Question 4 of 5
A nurse is monitoring a client who has a chest tube in place connected to wall suction due to a right-sided pneumothorax. The client complains of chest burning. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: Repositioning the client can help alleviate chest burning caused by the chest tube.
Question 5 of 5
A staff nurse is teaching a client who has Addison's disease about the disease process. The client asks the nurse what causes Addison's disease. Which of the following responses should the nurse make?
Correct Answer: A
Rationale:
Correct Answer: A
Rationale:
1. Addison's disease is characterized by adrenal insufficiency.
2. Aldosterone is a hormone produced by the adrenal gland that helps regulate blood pressure and electrolyte balance.
3. Lack of aldosterone production in Addison's disease leads to electrolyte imbalances and low blood pressure.
4.
Therefore, the correct answer is A as the lack of aldosterone production by the adrenal gland is the primary cause of Addison's disease.
Summary of other choices:
B. Addison's disease is not caused by a viral infection, so this choice is incorrect.
C. Addison's disease is not caused by the overproduction of cortisol, as it is associated with cortisol deficiency.
D. The most common cause of Addison's disease is an autoimmune disorder where the body attacks the adrenal glands, leading to their dysfunction.