ATI RN
ATI Advanced Med Surg Final Exam 0924 Questions
Extract:
Question 1 of 5
A nurse is presenting discharge instructions to a client who has multiple sclerosis (MS). The client reports symptoms of diplopia, dysmetria, and sensory change. Which of the following nursing statements are appropriate?
Correct Answer: D
Rationale: Incorporating periods of rest helps manage fatigue, a common symptom in MS, and prevents exacerbation of symptoms.
Question 2 of 5
A nurse in the emergency department is caring for a client who was injured in a motor-vehicle crash. The client reports dyspnea and severe pain. The nurse notes that the client's chest moves inward during inspiration and bulges out during expiration. The nurse should identify this finding as which of the following?
Correct Answer: B
Rationale: Flail chest is characterized by paradoxical chest movement where a segment of the chest wall moves inward during inspiration and outward during expiration.
Question 3 of 5
A nurse is teaching an assistive personnel (AP) about the purpose of a footplate on the bed of a client whose leg is in Buck's traction. Which of the following statements indicates the AP understands the teaching?
Correct Answer: B
Rationale: The footplate helps to prevent foot drop by maintaining proper alignment of the foot and leg in Buck's traction.
Extract:
Nurses' Notes
1000:
Client presents with reports of shortness of breath, dizziness, and "feelings of pressure" in jaw, neck, and left arm. Was mowing the lawn when feelings of discomfort began.
Denies chest pain, nausea, palpitations.
Provider updated, prescriptions received.
1010:
Nitroglycerin sublingual tablet administered x 3, 5 min apart. Updated provider on diagnostic results. Prescriptions received.
1025:
Client states relief from discomfort, no further shortness of breath, dizziness, or feelings of pressure, continues to deny chest pain.
Provider updated, prescriptions received.
Vital signs
Temperature 36.4°C (97.6°F)
Heart rate 112/min
Respiratory rate 28/min
Blood pressure 146/74 mm Hg
SaO2 93% on room air
1015:
Temperature 36.4°C (97.6°F)
Heart rate 92/min
Respiratory rate 24/min
Blood pressure 126/64 mm Hg
SaO, 96% on oxygen @ 2L/min via nasal cannula
Provider Prescriptions
1005:
12 Lead EKG
Serum cardiac enzymes
Nitroglycerin 0.3 mg sublingual now, may repeat every 5 min for 2 additional doses
Diagnostic Results
1010:
12 Lead EKG:
ST depression and T-wave inversion
Question 4 of 5
For each of the following findings in the client's medical record, click to specify if they are consistent with angina or a myocardial infarction (MI). Each finding may support more than one disease process.
| Options | Angina | Myocardial infarction |
|---|---|---|
| Provider consult | ||
| Client's initial report of manifestations | ||
| Treadmill stress test | ||
| Result of nitroglycerin therapy | ||
| 12 Lead EKG report |
Correct Answer: B,D,E
Rationale: Client's initial manifestations, nitroglycerin relief, and EKG changes are consistent with both angina and MI, though MI requires further confirmation.
Extract:
Question 5 of 5
A nurse is observing the closed chest drainage system of a client who is 24 hr post thoracotomy. The nurse notes slow, steady bubbling in the suction control chamber. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: Slow, steady bubbling in the suction control chamber may indicate that the suction control pressure needs adjustment.