ATI RN
ATI Advanced Med Surg Exam 3 Questions
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 1 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 2 of 5
Mr Jones came to the ER complaining of chest palpitations. He states his heart feels like it is 'racing'. The nurse found the following rhythm on the monitor. What is the next step would the nurse expect to take first?
Correct Answer: B
Rationale: The Valsalva maneuver, such as blowing into a syringe, can stimulate the vagus nerve to slow supraventricular tachycardia, making it the first non-invasive step.
Question 3 of 5
A client tells the nurse that he is concerned because his provider told him he has a heart murmur. The nurse should explain to the client that a murmur
Correct Answer: A
Rationale: A heart murmur is caused by turbulent blood flow, often due to valve abnormalities like stenosis or regurgitation.
Question 4 of 5
A nurse is caring for a patient with acute respiratory distress syndrome (ARDS) who is receiving mechanical ventilation using synchronized intermittent mandatory ventilation (SIMV). The settings include fraction of inspired oxygen (FIO2) of 80%, tidal volume of 450, rate of 16/minute, and positive end-expiratory pressure (PEEP) of 5 cm. Which assessment finding is most important for the nurse to report to the health care provider?
Correct Answer: D
Rationale: Crackles at lung bases indicate worsening pulmonary edema or fluid accumulation, requiring immediate reporting to adjust ventilator settings or interventions.
Question 5 of 5
A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. Which of the following actions should the nurse take to reduce the risk of ventilator-associated pneumonia?
Correct Answer: D
Rationale: Regular oral hygiene with a suction toothbrush reduces bacterial load, decreasing the risk of ventilator-associated pneumonia.