ATI RN
ATI Med Surg Adult Care 2 Questions
Extract:
Question 1 of 5
A nurse is performing a neurological assessment for a client with head trauma. Which of the following assessments will give the nurse information about the function of cranial nerve II?
Correct Answer: A
Rationale: This is the correct answer because cranial nerve II is the optic nerve, which is responsible for vision. Testing the client's ability to look up and down without moving his head assesses the function of this nerve.
Question 2 of 5
A nurse is providing education to a group of older adults about the risk of stroke. Which selections made by the group indicate an understanding of the teaching? Select All that Apply
Correct Answer: A,E
Rationale: Recognizing stroke symptoms (face, arm, speech changes) and lifestyle modifications (low sodium, limited alcohol, regular exercise) are correct stroke prevention strategies.
Question 3 of 5
A client is extremely drowsy, minimally responsive, and has a difficult time following commands. With vigorous stimulation the client awakens but quickly falls back asleep. What level of consciousness does this describe?
Correct Answer: B
Rationale: Obtunded is a state of decreased alertness and responsiveness, where the client is difficult to arouse and has limited interaction with the environment.
Question 4 of 5
A nurse is caring for a client who has an epidural hematoma. Which of the following manifestations should the nurse expect?
Correct Answer: D
Rationale: An epidural hematoma is caused by bleeding between the dura mater and the skull, usually from a ruptured artery. The bleeding can cause increased intracranial pressure, which can compress the brain and lead to a loss of consciousness.
Question 5 of 5
A nurse is assessing a client who has a score of 6 on the Glasgow Coma Scale. The nurse should expect which of the following outcomes based on this score?
Correct Answer: A
Rationale: A score of 6 on the Glasgow Coma Scale indicates severe brain injury and coma. The client would need total nursing care and close monitoring.