ATI RN
ATI Custom MS Nurse Questions
Extract:
Client with multiple sclerosis learning four-point alternate gait with crutches
Question 1 of 5
A nurse is reinforcing teaching with a client who has multiple sclerosis and is learning how to use the four-point alternate gait with crutches. Identify the order of the steps the nurse should give to the client.
Correct Answer: A,B,C,D
Rationale: The order of the steps for the four-point alternate gait with crutches is as follows: move the right crutch about 10 to 15 cm (4 to 6 in), move the left foot forward, move the left crutch forward, and move the right foot forward. This gait pattern provides maximum stability and support for the client by keeping three points of contact on the ground at all times.
Extract:
Client who had an open reduction internal fixation surgery
Question 2 of 5
A nurse is completing a neurovascular check for a client who had an open reduction internal fixation surgery. Which of the following findings should the nurse identify as possible manifestations of compartment syndrome?
Correct Answer: A,B,C
Rationale: The nurse should identify absence of pulse, altered sensation of the toes, and cool skin as possible manifestations of compartment syndrome. Compartment syndrome is a serious condition that can occur following surgery or injury, characterized by increased pressure within a muscle compartment that can lead to decreased blood flow and nerve damage.
Extract:
Client in halo traction to immobilize cervical spine
Question 3 of 5
A nurse is caring for a client who has been placed in halo traction to immobilize his cervical spine. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: Elevating the head of the bed can help improve the patient's comfort and reduce the risk of complications such as aspiration in a client with halo traction.
Extract:
Client at risk for stroke
Question 4 of 5
A nurse is planning care for several clients and is considering the clients' risk for stroke. Which of the following conditions places the client at risk for an ischemic embolic stroke?
Correct Answer: C
Rationale: A client who has chronic atrial fibrillation is at risk for an ischemic embolic stroke. An ischemic embolic stroke occurs when a blood clot that forms in one part of the body travels to the brain and blocks blood flow. Atrial fibrillation is a type of irregular heart rhythm that can cause blood to pool, thicken, and clot in the heart or arteries near it.
Extract:
Client in skeletal traction
Question 5 of 5
A client returns to the surgical unit from the PACU in skeletal traction. The nurses should take action to correct. Which of the following problems with the traction setup?
Correct Answer: A
Rationale: If a client returns to the surgical unit from the PACU in skeletal traction and the weights rest against the foot of the bed, the nurse should take action to correct this problem with the traction setup. The weights should be hanging freely and not touching any part of the bed or floor.