ATI RN
ATI N 1201222 Med Surg Final Exam Questions
Extract:
Question 1 of 5
A nurse is measuring a client's oral temperature. The client informs the nurse that he has just eaten some ice chips. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: Waiting 30 minutes allows the oral cavity to return to normal temperature, ensuring an accurate reading. Immediate measurement, documentation without action, or warm water skews results.
Question 2 of 5
The client diagnosed with paraplegia is being admitted to a medical unit from home with a stage IV pressure injury over the right ischium. Which assessment tool should be completed on admission to the hospital?
Correct Answer: B
Rationale: The Braden Scale assesses pressure ulcer risk factors, guiding care for a stage IV injury. Glasgow Coma Scale is for consciousness, Brudzinski for meningitis, and Babinski for neurological function.
Question 3 of 5
A nurse is teaching a client about the Rinne test. Which of the following client statements indicates an understanding of the teaching?
Correct Answer: D
Rationale: The Rinne test uses a tuning fork to compare air and bone conduction. Earphones, probes, and electrodes are unrelated.
Question 4 of 5
A client taking a newly prescribed monoamine oxidase inhibitor (MAOI) is receiving education on foods that contain tyramine. Which of the following foods should be excluded from the client's diet? (Select all that apply.)
Correct Answer: B,C,D
Rationale: Red wine, smoked sausage, and aged cheddar are high in tyramine, risking hypertensive crises with MAOIs. Chicken and cereal are safe.
Question 5 of 5
A nurse is caring for a client who has impaired mobility. Which of the following support devices should the nurse plan to use to prevent the client from developing plantar flexion contractures?
Correct Answer: C
Rationale: A footboard maintains dorsiflexion, preventing plantar flexion contractures. Trochanter rolls prevent hip rotation, heel pads protect skin, and abduction pillows align hips.