ATI RN
ATI Nur285 Med Surg Fall Exam Questions
Extract:
Question 1 of 5
A nurse is creating a plan of care to maintain the skin integrity of a client who experiences frequent diarrhea due to ulcerative colitis. Which of the following interventions should the nurse include in the plan?
Correct Answer: C
Rationale: Wiping the perianal area with warm water and applying a barrier cream is an appropriate and effective intervention to protect the skin. The warm water is gentle, and the barrier cream provides a protective layer that helps prevent skin breakdown from frequent contact with stool.
Extract:
Nurse's Notes: Client admitted to the unit 12 hr ago with pneumonia, over the last 1 hr the client has exhibited dyspnea and restlessness. Respiratory rate is currently 32/min with deep breaths, BP 198/78 mm Hg. Oxygen has been increased from 2 L nasal cannula to 50% face mask with little improvement of oxygen saturation. Current oxygen saturation is 91% on 50% facemask. Arterial blood gases drawn and sent to lab. Diagnostic Results: ABGS: pH 7.25 (7.35 to 7.45), pCO2 62 mm Hg (35 to 45 mm Hg), HCO3-22 mEq/L (22 to 26 mEq/L).
Question 2 of 5
A nurse is caring for a client who has pneumonia on a medical-surgical unit. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
Correct Answer: B
Rationale: The client's low pH and high pCO2 indicate respiratory acidosis. Preparing for intubation and administering a bronchodilator address respiratory distress, while monitoring arterial blood gases and ETT placement ensures effective treatment.
Extract:
Question 3 of 5
A nurse is caring for a client who has pneumonia. Which of the following actions should the nurse take to promote thinning of respiratory secretions?
Correct Answer: C
Rationale: Increasing fluid intake helps thin respiratory secretions by providing hydration, reducing the viscosity of sputum and aiding expectoration.
Question 4 of 5
A patient is being treated for bleeding esophageal varices with balloon tamponade. Which of the following nursing actions will the nurse include in the plan of care?
Correct Answer: B
Rationale: Monitoring vital signs frequently is critical in patients with bleeding esophageal varices, as they are at risk for hypovolemic shock. Vital signs should be monitored closely to assess for signs of bleeding, hemodynamic instability, and response to interventions.
Question 5 of 5
A nurse in a provider's office is assessing an older adult client whose son reports that the client has been sick with a respiratory illness for the past 6 days. Which of the following assessment findings is a manifestation of pneumonia in the older adult client?
Correct Answer: C
Rationale: Confusion is a classic symptom of pneumonia in older adults, often due to hypoxia or infection-related mental status changes.