ATI LPN
ATI LPN Med Surg Level 3 II Questions
Extract:
Question 1 of 5
A nurse is counting a client's apical pulse rate. Identify where the nurse should place the stethoscope to auscultate the apical pulse.
Correct Answer: A
Rationale: The apical pulse is auscultated at the fifth intercostal space, midclavicular line, where the heart's apex is located.
Question 2 of 5
A nurse is collecting data about a client's circulatory system. Which of the following pulse sites should the nurse avoid checking bilaterally at the same time?
Correct Answer: D
Rationale: Checking carotid pulses bilaterally simultaneously can reduce cerebral blood flow, risking syncope. One side should be palpated at a time.
Question 3 of 5
When a nurse obtains an unusually low blood pressure measurement for a client whose blood pressure is generally elevated, she considers the possibility of a problem with her technique. Which of the following sources of error should she consider as a possible cause of the low reading?
Correct Answer: B
Rationale: Positioning the arm above heart level can falsely lower BP readings. The arm should be at heart level for accuracy.
Question 4 of 5
A nurse is caring for a client who has hypertension and recently developed drooping facial features. When contacting the provider, which of the following statements should the nurse include as part of the background component of the SBAR communication tool?
Correct Answer: D
Rationale: The background component of SBAR provides relevant medical history. The client's history of hypertension is pertinent to the current situation and should be included in the background. The other options belong to different SBAR components: A (recommendation), B (assessment), and C (situation).
Question 5 of 5
A nurse is reinforcing teaching to a client who is postmenopausal about reducing the risk of coronary artery disease. Which of the following statements by the client indicates an understanding of the teaching?
Correct Answer: D
Rationale: Omega-3 fatty acids reduce triglycerides and inflammation, lowering coronary artery disease risk, reflecting correct understanding.