ATI LPN
PN Adult Medical Surgical 2023 Questions
Extract:
Question 1 of 5
A nurse is reviewing vital signs obtained by an assistive personnel on a group of clients. The previous vital signs for each of the clients were obtained 4 hr earlier. Which of the following changes should the nurse identify as the priority finding?
Correct Answer: C
Rationale: Using the ABCs, blood pressure dropping from 118/78 to 86/50 mm Hg signals potential shock or hypoperfusion, a circulation emergency requiring immediate assessment. Heart rate falling from 110 to 68 could reflect recovery (e.g., post-tachycardia) or bradycardia, but without symptoms, it's less urgent. Respiratory rate rising from 12 to 20 suggests compensation or distress, but circulation trumps breathing in acuity here. Temperature jumping to 38.8°C indicates fever, possibly infection, but hemodynamic instability is more immediately life-threatening. A systolic drop to 86 mm Hg risks organ perfusion, aligning with triage priorities hypotension could stem from bleeding, dehydration, or sepsis, needing rapid provider notification. This finding drives urgent intervention, making it the nurse's top concern.
Question 2 of 5
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Question 3 of 5
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Question 4 of 5
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Question 5 of 5
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