Questions 63

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ATI Med Surg Exam N300 Exam Day Questions

Extract:


Question 1 of 5

A patient diagnosed with a seizure disorder tells the nurse that they feel like they have 'butterflies' in their stomach. The patient has felt this in the past before having a seizure. The nurse recognizes that this feeling is:

Correct Answer: C

Rationale: An aura is a perceptual disturbance experienced by some patients with seizure disorders that precedes a seizure. It can manifest as various sensations, including gastrointestinal feelings like 'butterflies,' which serve as a warning sign.

Question 2 of 5

A nurse is assigned a patient diagnosed with acquired immunodeficiency syndrome (AIDS). Which type of precaution should be used when providing direct care?

Correct Answer: A

Rationale: Standard precautions should be used for all patients, including those with AIDS, as they are designed to prevent the transmission of infections regardless of the patient's diagnosis.

Question 3 of 5

A patient is ordered 1 mg of Morphine IV push. The medication is supplied in vials 2 mg/1 mL. What should the nurse administer? (round to the nearest tenth)

Correct Answer: 0.5 mL

Rationale:
To administer the correct dose of Morphine, the nurse needs to calculate the volume of medication to deliver 1 mg of Morphine. Since the medication is supplied in a concentration of 2 mg per 1 mL, the nurse would administer half of the volume of the vial to provide the ordered 1 mg dose.
Therefore, the nurse should administer 0.5 mL of Morphine to the patient.

Question 4 of 5

The nurse is caring for a patient with an acute brain injury. Which of the following sets of vital signs would concern the nurse about increasing intracranial pressure (ICP)?

Correct Answer: B

Rationale: This set of vital signs is concerning due to the extremely high blood pressure (220/46) combined with a very low heart rate (30) and low respiratory rate (6), which can indicate an autonomic response to increased ICP, potentially leading to Cushing's triad.

Question 5 of 5

The nurse is caring for a patient in the acute care setting with a spinal cord injury (SCI) at the level of C-3. What is the main cause of complications or death related to this injury?

Correct Answer: D

Rationale: Respiratory compromise is the primary cause of complications or death in patients with a high cervical spine injury (C-3 and above) due to loss of innervation to the diaphragm and intercostal muscles, which impairs spontaneous breathing.

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