ATI RN
ATI RN Custom Med Surg Surgical patient Questions
Extract:
Question 1 of 5
A nurse is caring for a patient who is postoperative following a total knee replacement. What action should the nurse take to prevent deep vein thrombophlebitis?
Correct Answer: A
Rationale: Encouraging fluid intake reduces blood viscosity, promotes circulation, and enhances fibrinolysis, preventing DVT. Flexing the knee can impede blood flow. Prolonged bed rest increases DVT risk. Massaging the calf can dislodge clots, causing embolism.
Question 2 of 5
A nurse is caring for a patient who is postoperative following a total knee replacement. What action should the nurse take to prevent deep vein thrombophlebitis?
Correct Answer: A
Rationale: Encouraging fluid intake reduces blood viscosity, promotes circulation, and enhances fibrinolysis, preventing DVT. Flexing the knee can impede blood flow. Prolonged bed rest increases DVT risk. Massaging the calf can dislodge clots, causing embolism.
Question 3 of 5
A nurse notes a small section of bowel protruding from the abdominal incision of a client who is postoperative. After calling for assistance, which of the following actions should the nurse take first?
Correct Answer: D
Rationale: Covering the protruding bowel with a moist, sterile dressing prevents dehydration and infection. Vital signs, informing the client, and positioning are secondary to protecting the bowel.
Question 4 of 5
A nurse is caring for a patient on the third day following abdominal surgery. The nurse notes the absence of bowel sounds, abdominal distention, and the patient has not passed any flatus. Which postoperative complication is the patient likely experiencing?
Correct Answer: A
Rationale: Paralytic ileus is a common postoperative complication characterized by slowed or stopped intestinal peristalsis, leading to gas and fluid buildup, causing abdominal distention, nausea, and constipation. The absence of bowel sounds, distention, and lack of flatus are hallmark signs. Incisional infection presents with localized symptoms like redness and pain at the incision site. Fecal impaction involves a hard stool mass in the rectum, not typically linked to absent bowel sounds. Clostridium difficile infection causes diarrhea, not the symptoms described.
Question 5 of 5
A patient has been diagnosed with septic shock. What collaborative interventions would be expected? (Select all that apply)
Correct Answer: A,B,E,F
Rationale: Temperature control, cardiotonic agents, blood cultures, and fluid resuscitation address septic shock's effects and causes. Thrombolytics and epinephrine are not standard interventions.