ATI RN
ATI Nurs285 Med Surg Exam Questions
Extract:
Question 1 of 5
During assessment of a client on the respiratory unit, the pulse oximetry monitor indicates a drop of SpO2 from 98% to 87% over four hours in a client who previously had normal range oxygen saturation level. Which of the following actions should the nurse perform first?
Correct Answer: B
Rationale: Checking the pulse oximeter probe position ensures the reading's accuracy, as faulty placement can cause false lows. This step precedes oxygen administration or further assessment.
Question 2 of 5
A patient is admitted to the respiratory unit with flail chest. The nurse understands that a flail chest is:
Correct Answer: A
Rationale: Flail chest is characterized by multiple rib fractures creating a free-floating chest wall segment that moves paradoxically, impairing ventilation. Other options describe different conditions.
Question 3 of 5
A client had a right-sided chest tube inserted two hours ago for pneumothorax. Which action should the nurse implement if there is no fluctuation in the water seal compartment?
Correct Answer: A
Rationale: Lack of fluctuation in the water seal compartment may indicate kinks, obstructions, or lung re-expansion. The nurse should first check the chest tube system for issues before escalating or adjusting suction.
Question 4 of 5
A patient who is experiencing an acute asthma attack is admitted to the emergency department. Which assessment should the nurse complete first?
Correct Answer: C
Rationale: Assessing lung sounds first provides critical information about airway obstruction severity, guiding immediate interventions for an acute asthma attack.
Question 5 of 5
A patient with asthma presents with daily peak flow rates consistently at 45% of their personal best. What is the most appropriate action the nurse should take?
Correct Answer: D
Rationale: Peak flow rates at 45% indicate poor asthma control, requiring initiation of an asthma action plan and oral corticosteroids to manage the exacerbation.