ATI RN
ATI RN Adult Medical Surgical 2023 Questions
Extract:
Question 1 of 5
A nurse is performing a cranial nerve assessment on a client following a head injury. Which of the following findings should the nurse expect if the client has impaired function of the vestibulocochlear nerve (cranial nerve VIII)?
Correct Answer: C
Rationale: The vestibulocochlear nerve (cranial nerve VIII) is responsible for balance and hearing; impaired function leads to disequilibrium with movement.
Question 2 of 5
A nurse is caring for a client who has acute heart failure and received morphine IV 30 min ago. Which of the following findings should the nurse identify as an indication that the medication was effective?
Correct Answer: C
Rationale: Morphine reduces anxiety and preload in acute heart failure, improving comfort and breathing.
Extract:
Physical Examination
Jaundice
Orange-brown colored urine
Positive hemoccult blood
Abdominal distention
Lethargy
1+ edema
Oriented x4
Tachydysrhythmia
Dyspnea with exertion
A nurse is admitting a middle adult client who has cirrhosis. Findings upon admission:
Question 3 of 5
A nurse is admitting a middle adult client who has cirrhosis. Findings upon admission: The nurse is assessing the client 24 hr later. How should the nurse interpret the findings? For each finding, click to specify whether the finding is unrelated to the diagnosis, a sign of potential improvement, or a sign of potential worsening condition.
| Options | Unrelated to diagnosis | Indication of Potential Improvement | Indication of Potential Worsening Condition |
|---|---|---|---|
| Spontaneous bruising | |||
| Ascites | |||
| Increased albumin level | |||
| Hematemesis | |||
| Elevated iron levels |
Correct Answer:
Rationale: Spontaneous bruising and hematemesis worsen cirrhosis; ascites is related; increased albumin improves; iron is unrelated.
Extract:
Question 4 of 5
A nurse is caring for a client who is receiving a 0.9% sodium chloride via IV infusion. The client has become dyspneic with a blood pressure of 140/100 mm Hg, a fluid intake of 960 mL, and an output of 300 mL in the past 12 hr. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: Dyspnea and fluid overload signs require slowing the infusion and notifying the provider.
Question 5 of 5
A nurse is teaching the family of a client who has Alzheimer's disease about caring for the client at home. Which of the following instructions should the nurse include?
Correct Answer: D
Rationale: A calendar aids orientation in Alzheimer's disease.