ATI RN
ATI RN Adult Medical Surgical 2023 Questions Correct Answers Questions
Extract:
Question 1 of 5
A nurse is providing discharge teaching to a client who has COPD. Which of the following instructions should the nurse include in the teaching?
Correct Answer: A
Rationale: The correct answer is A: Consume a diet that is high in calories. Patients with COPD often have increased energy needs due to the increased work of breathing. Providing a high-calorie diet helps maintain energy levels and prevent weight loss.
Choice B is incorrect because adequate hydration is crucial to help thin mucus and make it easier to clear from the airways.
Choice C is incorrect as strenuous exercise can exacerbate COPD symptoms; moderate exercise is recommended.
Choice D is incorrect because carbohydrates are an essential energy source and reducing intake can lead to increased fatigue in COPD patients.
Question 2 of 5
A nurse is providing discharge teaching to a client following a modified left radical mastectomy with breast expander. Which of the following statements by the client indicates an understanding of the teaching?
Correct Answer: B
Rationale: The correct answer is B: "I should expect less than 25 mL of secretions per day in the drainage devices." This demonstrates an understanding of the need to monitor drainage postoperatively. Excessive drainage can indicate complications like infection or bleeding.
A: Performing strength-building exercises with a 15-pound weight is contraindicated postoperatively as it can strain the surgical site.
C: Waiting 2 months before adding saline to the expander is incorrect. Saline can be added gradually postoperatively.
D: Keeping the left arm flexed at the elbow is not recommended as it can lead to stiffness and limited range of motion.
Question 3 of 5
A nurse in the PACU is caring for a client. Which of the following assessments is the nurse's priority?
Correct Answer: D
Rationale: The correct answer is D: Respiratory status. In the PACU, ensuring adequate oxygenation and ventilation is crucial for the client's immediate postoperative recovery. Monitoring respiratory status helps prevent complications like hypoxia or respiratory distress. Assessing the airway, breathing rate, depth, and oxygen saturation takes precedence over other assessments. Level of consciousness (
A) is important but can be affected by respiratory issues. Surgical site (
B) assessment is important but not an immediate priority. Pain level (
C) is important but can be managed once respiratory status is stable. Summary: Respiratory status is the priority as it directly impacts the client's immediate well-being and recovery.
Question 4 of 5
A nurse is monitoring a client who has a traumatic brain injury. Which of the following findings should the nurse identify as a manifestation of Cushing's triad?
Correct Answer: A
Rationale: The correct answer is A because Cushing's triad consists of hypertension, bradycardia, and irregular respirations. In a client with a traumatic brain injury, increased intracranial pressure can lead to Cushing's triad due to brainstem compression. Option A reflects an increase in blood pressure, which is a key component of Cushing's triad.
Choices B, C, and D do not align with the expected findings of Cushing's triad.
Choice B indicates a decrease in heart rate, which is contrary to the bradycardia seen in Cushing's triad.
Choice C mentions rapid respirations, whereas irregular or shallow respirations are more characteristic.
Choice E mentions hypotension, which is not part of Cushing's triad.
Therefore, option A is the correct choice as it aligns with the manifestation of hypertension in Cushing's triad.
Question 5 of 5
A nurse is caring for a client who has acute angina. Which of the following actions should the nurse take first?
Correct Answer: B
Rationale: The correct answer is B: Administer aspirin. Administering aspirin is the priority action for a client with acute angina as it helps in reducing platelet aggregation and improving blood flow to the heart. This action can potentially prevent further clot formation and decrease the risk of a heart attack. It is essential to address the acute symptoms first before proceeding with other interventions. Measuring blood pressure (
A), administering nitroglycerin (
C), and initiating IV access (
D) are important actions but administering aspirin takes precedence in this scenario to address the acute angina symptoms promptly.