ATI RN
ATI Med Surg Custom N235 Final Summer 2023 Questions
Extract:
Question 1 of 5
A nurse is caring for a female client in the emergency department who reports shortness of breath and pain in the lung area. She states that she started taking birth control pills 3 weeks ago and that she smokes. Her heart rate is 110/min, respiratory rate 40/min, and blood pressure 140/80 mm Hg. Her arterial blood gases are pH 7.50, PaCO2 29 mm Hg, PaO2 60 mm Hg, HCO3 20 mEq/L, and SaO2 86%. Which of the following is the priority nursing intervention?
Correct Answer: B
Rationale: Low PaO2 (60 mm Hg) and SaO2 (86%) indicate hypoxemia; oxygen administration is the priority.
Question 2 of 5
A nurse in an emergency department is caring for a client who has a sucking chest wound resulting from a gunshot. The client has a blood pressure of 100/60 mm Hg, a weak pulse rate of 118/min, and a respiratory rate of 40/min. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: Tachypnea and hypotension indicate hypoxemia; oxygen administration is the priority.
Question 3 of 5
A nurse is caring for a female client in the emergency department who reports shortness of breath and pain in the lung area. She states that she started taking birth control pills 3 weeks ago and that she smokes. Her heart rate is 110/min, respiratory rate 40/min, and blood pressure 140/80 mm Hg. Her arterial blood gases are pH 7.50, PaCO2 29 mm Hg, PaO2 60 mm Hg, HCO3 20 mEq/L, and SaO2 86%. Which of the following is the priority nursing intervention?
Correct Answer: B
Rationale: Low PaO2 (60 mm Hg) and SaO2 (86%) indicate hypoxemia; oxygen administration is the priority.
Question 4 of 5
A nurse is caring for a client who had an evacuation of a subdural hematoma. Which of the following actions should the nurse take first?
Correct Answer: B
Rationale: Checking the oximeter first assesses oxygenation status, which is critical post-surgery and aligns with the priority of ensuring adequate breathing.
Question 5 of 5
The nurse is caring for a postoperative client who has a chest tube connected to suction and a water seal drainage system. Which of the following indicates to the nurse that the chest tube is functioning properly?
Correct Answer: B
Rationale: Fluctuation in the water seal chamber indicates the chest tube is patent and functioning, reflecting normal respiratory pressure changes.