ATI RN
ATI Custom Medical Surgical Nurse Exam 2 Questions
Extract:
Question 1 of 5
A nurse is collecting data from a client who has a traumatic head injury. Which of the following findings should the nurse report to the provider immediately?
Correct Answer: A
Rationale: Sudden sleepiness may indicate increased intracranial pressure, a life-threatening complication requiring immediate reporting. Headache, diplopia, and ataxia are concerning but less urgent.
Question 2 of 5
A nurse is caring for a client who is 2 days postoperative following an above-the-knee amputation. Which of the following is an appropriate nursing intervention for the client at this time?
Correct Answer: D
Rationale: Lying prone prevents hip flexion contractures, a common complication post-amputation. Elevating the bed or stump and excessive sitting are not recommended at this stage.
Question 3 of 5
A nurse is caring for a client who has a spinal cord injury at T-4. The nurse should recognize that the client is at risk for autonomic dysreflexia. Which of the following interventions should the nurse take to prevent autonomic dysreflexia?
Correct Answer: C
Rationale: Preventing bladder distention reduces the risk of autonomic dysreflexia, which can be triggered by a full bladder or bowels. Monitoring and analgesia are not preventive measures.
Question 4 of 5
A nurse is caring for a client who sustained a basal skull fracture. When performing morning hygiene care, the nurse notices a thin stream of clear drainage coming from out of the client's right nostril. Which of the following actions should the nurse take first?
Correct Answer: A
Rationale: Testing for glucose identifies a cerebrospinal fluid leak, a critical finding requiring immediate action. Other steps follow but are not the first priority.
Question 5 of 5
A nurse is caring for a client who has osteoporosis and is taking calcium carbonate. The nurse should monitor the client for which of the following adverse effects?
Correct Answer: C
Rationale: Flank pain may indicate kidney stones, a potential side effect of calcium carbonate. Urinary retention, tinnitus, and bradycardia are not commonly associated.