Questions 71

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ATI PN Adult Medical Surgical 2020 with NGN II Questions

Extract:


Question 1 of 5

A nurse is monitoring a client who is undergoing a blood transfusion of packed RBCs. The nurse should recognize that which of the following findings indicates fluid overload?

Correct Answer: A

Rationale: Dyspnea indicates fluid overload during transfusion, as excess volume can lead to pulmonary congestion, requiring immediate intervention.

Question 2 of 5

A charge nurse is reinforcing teaching about infection control with a newly licensed nurse. Which of the following actions by the newly licensed nurse indicates an understanding of the teaching?

Correct Answer: B

Rationale: Cleaning a blood spill with chlorine bleach effectively disinfects surfaces, demonstrating proper infection control.

Question 3 of 5

A nurse is assisting with discharge teaching for a client who requires oropharyngeal suctioning at home. The nurse should ensure that which of the following equipment is available for use at home?

Correct Answer: A

Rationale: A Yankauer catheter is essential for effective oropharyngeal suctioning at home, allowing removal of secretions from the mouth and throat.

Question 4 of 5

A nurse is reinforcing teaching with a client who has a new prescription for warfarin. Which of the following statements by the client indicates a need for further teaching?

Correct Answer: D

Rationale: Taking an antacid with warfarin can alter its absorption, indicating a need for further teaching to ensure proper administration.

Question 5 of 5

A nurse is assisting with care for a client who received a tuberculin skin test 72 hours ago. When collecting data from the test site, which of the following findings indicates a need for further testing?

Correct Answer: A

Rationale: A palpable induration greater than 10 mm indicates possible tuberculosis exposure, necessitating further diagnostic testing.

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