ATI RN
ATI Advanced Med Surg Exam 4 Questions
Extract:
Question 1 of 5
Following an earthquake, patients are triaged by emergency medical personnel and transported to the emergency department (ED). Which patient will the nurse need to assess first?
Correct Answer: D
Rationale: Red-tagged patients have critical conditions requiring immediate assessment.
Question 2 of 5
During the primary survey of a patient with severe leg trauma, the nurse observes that the patient's left pedal and posterior tibial pulses are absent, and the entire leg is swollen. Which action will the nurse take next?
Correct Answer: C
Rationale: Further assessment for the cause of decreased circulation is critical to prevent limb loss.
Extract:
Nurses' Notes
40-year-old client is 2 days post-op following a renal transplant. Client alert and oriented x3. Sitting in high Fowler's. Skin warm and dry. Client reports pain at incision site as 5 on a scale of 0 to 10. Incision approximated, sutures intact. No drainage noted. Heart sounds regular. Lung sounds diminished throughout. Instructed to use incentive spirometer. Abdomen soft and non-distended. Bowel sounds hypoactive x4. 1+ peripheral edema noted bilaterally. Foley catheter patent, urine pink tinged. Urine output in last hour 1500mL
Vital Signs
Temperature 37.7° C (99.8° F)
Heart rate 110/min
Respiration rate 24/min
BP 94/56 mm Hg
Oxygen saturation 96% on room air
Question 3 of 5
A nurse is caring for a 40-year-old client in a transplant unit. 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: A, A, C, A, B
Rationale: Hypovolemia indicated by high urine output and low BP. Lower bed and IV bolus address hypovolemia; monitor urine output and BP.
Extract:
Question 4 of 5
A nurse is caring for a client who has myelosuppression after receiving chemotherapy. The nurse should monitor the client for which of the following adverse effects?
Correct Answer: D
Rationale: Myelosuppression reduces platelets, increasing bleeding risk, such as from gums.
Question 5 of 5
A patient is admitted to the hospital with acute rejection of a kidney transplant. Which intervention will the nurse expect for this patient?
Correct Answer: D
Rationale: Mycophenolate is an immunosuppressant used to manage acute rejection.