Questions 60

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ATI Advanced Med Surg Exam 3 Questions

Extract:


Question 1 of 5

A nurse is suctioning the endotracheal tube of a client who is on a ventilator. The client's heart rate increases from 86/min to 110/min and becomes irregular. Which of the following actions should the nurse take?

Correct Answer: B

Rationale: Pre-oxygenation prevents hypoxemia during suctioning, which can cause tachycardia and arrhythmias.

Question 2 of 5

Which is(are) potential result(s) of end-organ damage from chronic hypertension? (Select all that apply.)

Correct Answer: A,B,C,E

Rationale: Chronic hypertension damages the heart, kidneys, brain, and predisposes to atrial fibrillation, leading to cardiac disease, renal insufficiency, stroke, and arrhythmias.

Extract:

Nurses' Notes
0930:
The client arrives to the ED and reports a "fluttering" and "racing" heartbeat. The client also reports dizziness and shortness of breath.
0945:
Client placed on telemetry, cardiac rhythm is irregular, tachycardia and has unclear P waves. 0955:
Doctor in to assess patient. Orders received.

Vital Signs
0940:
Blood pressure 165/88 mm Hg Pulse rate 126/min Respiratory rate 22/min
Oxygen saturation 94% on room air


Question 3 of 5

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Correct Answer:

Rationale:

Extract:


Question 4 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 is normal, so continued monitoring of respiratory status is appropriate.

Question 5 of 5

Which information about a patient who is receiving cisatracurium (Nimbex) to prevent asynchronous breathing with the positive pressure ventilator requires action by the nurse?

Correct Answer: D

Rationale: Cisatracurium causes paralysis, requiring sedation to ensure patient comfort and prevent awareness, making the lack of a sedative order a priority for action.

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