ATI RN
ATI RN Adult Medical Surgical 2023 Questions Questions
Extract:
Question 1 of 5
A nurse is preparing to receive a client from surgery following a transverse colon resection with colostomy placement. The nurse should expect to assess the stoma at which of the following locations? (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.)
Correct Answer:
Rationale:
Correct Answer: B
Rationale: The correct location to assess the stoma following a transverse colon resection with colostomy placement is at location B, which is in the left lower quadrant. This is because the transverse colon is typically located in the upper abdomen, and the stoma would be brought out at the most dependent portion of the colon, which is in the left lower quadrant. Assessing the stoma in this location allows the nurse to monitor for proper stoma function and potential complications.
Summary:
A: Incorrect - Location A is in the right upper quadrant, which is not the typical site for a stoma following a transverse colon resection.
C: Incorrect - Location C is in the left upper quadrant, which is also not the typical site for a stoma after this surgery.
D, E, F, G: Not applicable as they are not relevant to the question.
Question 2 of 5
A nurse is planning care for an older adult client who has a history of dementia and is admitted following surgical repair of a hip fracture. Which of the following actions should the nurse plan to take?
Correct Answer: C
Rationale: The correct answer is C: Play serene soothing music. Music therapy has been shown to be effective in reducing anxiety and agitation in individuals with dementia. Serene music can help create a calming environment, promoting relaxation and potentially improving the client's overall well-being. Encouraging visits from friends (
Choice
A) may overwhelm the client with dementia. Applying restraints to the upper extremities (
Choice
B) is not recommended as it can lead to physical and psychological harm. Keeping the over-the-bed light on (
Choice
D) may disrupt the client's sleep and exacerbate confusion.
Question 3 of 5
A nurse is providing teaching for a client who is taking isoniazid (INH) for tuberculosis. Which of the following statements by the client indicates an understanding of the teaching?
Correct Answer: D
Rationale: The correct answer is D: "I will have my liver function tested while I am taking this medication." This is the correct answer because isoniazid (INH) is known to potentially cause liver toxicity. Monitoring liver function tests is crucial to detect any signs of liver damage early.
Choice A is incorrect as INH treatment for tuberculosis typically lasts 6-9 months, not just 1 week.
Choice B is incorrect because antacids can decrease the absorption of INH.
Choice C is incorrect as INH does not typically cause an increase in blood pressure.
Question 4 of 5
A nurse is caring for a client who has left-sided heart failure. Which of the following findings should indicate to the nurse that the client is experiencing a decrease in cardiac output?
Correct Answer: D
Rationale: The correct answer is D: Dyspnea. In left-sided heart failure, the heart is unable to pump efficiently, leading to a decrease in cardiac output. Dyspnea (shortness of breath) occurs due to the accumulation of fluid in the lungs (pulmonary congestion), indicating decreased cardiac output. Weight gain (
A) and distended abdomen (
B) are more indicative of right-sided heart failure. Confusion (
C) can be a sign of decreased cerebral perfusion, but dyspnea is a more direct indicator of decreased cardiac output in left-sided heart failure.
Question 5 of 5
A nurse is caring for a client who is postoperative following a below-the-knee amputation. Which of the following statements made by the client indicates acceptance of their altered body image?
Correct Answer: A
Rationale: The correct answer is A because the statement indicates the client's willingness to connect with someone who has undergone a similar experience, showing acceptance and readiness to learn from others in similar situations. This demonstrates the client's acknowledgment of their altered body image and a proactive approach towards coping with it positively.
Choice B reflects avoidance behavior, not acceptance.
Choice C focuses on the relief of pain rather than acceptance of body image changes.
Choice D suggests resignation rather than acceptance.