ATI RN
ATI Med Surg Exam 9 Questions
Extract:
Question 1 of 5
A nurse is performing a focused assessment for a client's vision. What visual assessment is the nurse making when she extends her hand for the client to shake?
Correct Answer: B
Rationale: Depth perception is the ability to judge the distance and position of objects in three-dimensional space. Depth perception is assessed by asking the client to touch the tip of a pen or pencil held by the nurse, or by using a stereopsis test. Peripheral vision is the ability to see objects and movements outside the direct line of vision. Peripheral vision is assessed by asking the client to shake the hand of the nurse, who stands at an angle to the client's side, or by using a confrontation test. Color deficit is the inability to distinguish certain colors or shades of colors. Color deficit is assessed by asking the client to identify numbers or shapes on a color plate test, such as the Ishihara test. Double vision is the perception of two images of a single object. Double vision is assessed by asking the client to cover one eye and look at an object, then switch eyes and compare the images, or by using a cover-uncover test.
Question 2 of 5
A client arrives to the emergency department after losing consciousness during a soccer game. Which of the following actions should the nurse take first?
Correct Answer: B
Rationale: Calculating a Glasgow Coma Score is the first action to assess the client's level of consciousness based on eye opening, verbal response, and motor response. This helps determine the severity of potential brain injury and guides further interventions.
Question 3 of 5
The client inquires what the positive result from the potassium hydroxide (KOH) test indicates. Which of the following is an accurate response by the nurse?
Correct Answer: B
Rationale: A positive KOH test indicates a fungal infection, as it reveals fungal elements under a microscope.
Question 4 of 5
Which of the following clients is most at risk for traumatic brain injury?
Correct Answer: A
Rationale: Reason: This is the correct choice because driving a motorcycle is a high-risk activity that can expose the client to head trauma, especially if they do not wear a helmet. Traumatic brain injury (TBI) is a condition where the brain is damaged by an external force, such as a collision, fall, or assault. Reason: This is incorrect because having high blood pressure is not a direct risk factor for traumatic brain injury. High blood pressure can increase the risk of stroke, which is a condition where the brain is damaged by an internal cause, such as a blood clot or hemorrhage. Reason: This is incorrect because smoking and having a family history of brain cancer are not risk factors for traumatic brain injury. Smoking and genetic factors can increase the risk of developing brain tumors, which are abnormal growths of cells in the brain. Reason: This is incorrect because golfing and driving a golf cart are low-risk activities that do not pose a significant threat to the client's head. Golfing and driving a golf cart may cause minor injuries, such as sprains, strains, or bruises, but not traumatic brain injury.
Question 5 of 5
A nurse is caring for a client who is postoperative from glaucoma surgery in the right eye. Which of the following will the nurse include in the postoperative education to the client? (Select all that apply)
Correct Answer: C,E,F
Rationale: These instructions ensure proper recovery by monitoring for complications, avoiding activities that increase intraocular pressure, and reassuring about normal post-surgical phenomena.