ATI RN
ATI Med Surg Adult Care 2 Questions
Extract:
Question 1 of 5
A nurse is creating a plan of care for a client who has a history of tonicclonic seizure disorder. Which of the following interventions should the nurse Include? (Select all that apply.)
Correct Answer: B,C,D,E
Rationale: Elevating side rails, placing the bed in the lowest position, providing suction, and keeping oxygen at the bedside are all appropriate interventions to ensure safety and manage potential complications during a seizure.
Question 2 of 5
A nurse is performing a neurological assessment for a client with head trauma. Which of the following assessments will give the nurse information about the function of cranial nerve II?
Correct Answer: A
Rationale: This is the correct answer because cranial nerve II is the optic nerve, which is responsible for vision. Testing the client's ability to look up and down without moving his head assesses the function of this nerve.
Extract:
You admit a client on day 1. After several days off, you are reassigned the same client. Click the tabs to review vital signs and nurse notes to review the client's progression.
Vital Signs Assessment Day 1:
Temperature 37.5° C (99.5° F) Blood pressure 198/96 mm Hg Heart rate 112/min
Respiratory rate 22/min
Oxygen saturation 96% on room air Day 7:
Temperature 38° C (100,4° F) Blood pressure 166/70 mm Hg Heart rate 68/min
Respiratory rate 20/min
Oxygen saturation 97% on room air
Question 3 of 5
For each client finding, click to specify if the finding could indicate Parkinson's disease, stroke, and/or multiple sclerosis. Each finding can support more than one disease process.
| Finding | Parkinson's disease | stroke | multiple sclerosis |
|---|---|---|---|
| Blood pressure | |||
| Facial symmetry | |||
| Cognitive function | |||
| Mobility status | |||
| Speech |
Correct Answer: A,B,C,D,E
Rationale: Blood pressure changes can occur in stroke and MS due to autonomic dysfunction. Facial asymmetry is common in stroke. Cognitive impairment can occur in all three. Mobility issues are seen in all three due to motor deficits. Speech difficulties can occur in stroke and MS.
Extract:
Question 4 of 5
A client arrives to the emergency department after a motor vehicle accident. The nurse records the following Glasgow Coma scores: E3, V2, M1. What is the best first action for the nurse to take.
Correct Answer: D
Rationale: Prepare the client for mechanical ventilation. This is the best first action because the client has Saclay has a very low Glasgow Coma score and may lose the ability to breathe spontaneously or maintain adequate oxygenation.
Question 5 of 5
Which of the following clients is most at risk for traumatic brain injury?
Correct Answer: C
Rationale: A 18year old highschool graduate who is enrolling in the Army: This is correct because military personnel are at high risk of traumatic brain injury due to exposure to blasts, projectiles, falls, and assaults.