ATI RN
ATI Med Surg Adult Care 2 Questions
Extract:
You admit a client on day 1. After several days off, you are reassigned the same client. Click the tabs to review vital signs and nurse notes to review the client's progression.
Vital Signs Assessment Day 1:
Temperature 37.5° C (99.5° F) Blood pressure 198/96 mm Hg Heart rate 112/min
Respiratory rate 22/min
Oxygen saturation 96% on room air Day 7:
Temperature 38° C (100,4° F) Blood pressure 166/70 mm Hg Heart rate 68/min
Respiratory rate 20/min
Oxygen saturation 97% on room air
Question 1 of 5
For each client finding, click to specify if the finding could indicate Parkinson's disease, stroke, and/or multiple sclerosis. Each finding can support more than one disease process.
| Finding | Parkinson's disease | stroke | multiple sclerosis |
|---|---|---|---|
| Blood pressure | |||
| Facial symmetry | |||
| Cognitive function | |||
| Mobility status | |||
| Speech |
Correct Answer: A,B,C,D,E
Rationale: Blood pressure changes can occur in stroke and MS due to autonomic dysfunction. Facial asymmetry is common in stroke. Cognitive impairment can occur in all three. Mobility issues are seen in all three due to motor deficits. Speech difficulties can occur in stroke and MS.
Extract:
Question 2 of 5
When providing education to a student nurse about ways to avoid increased intracranial pressure, which of the following will the nurse include in the instructions? (Select All that Apply.)
Correct Answer: A,B,C,D
Rationale: Consulting with dietary to manage fluid and sodium intake, keeping the head at 25 degrees or lower to promote venous drainage, dimming lights to reduce stimulation, and ordering a stool softener to prevent straining are all measures to avoid increased ICP.
Question 3 of 5
A 70year old client diagnosed with a hemorrhagic stroke was admitted 1 day ago. His medical history includes hypertension, osteoarthritis, and type 2 diabetes. He has right sided paralysis, garbled speech, and a weak cough reflex. This morning he is restless. Vital signs are Blood Pressure 160/80, pulse 110, respirations 24, oxygen saturation 90% Which of the following Interventions will the nurse take to avoid complications? Select all that apply
Correct Answer: A,B,C
Rationale: Applying oxygen addresses low saturation, monitoring blood pressure prevents further bleeding, and seizure precautions are necessary due to stroke-related seizure risk.
Question 4 of 5
A nurse is caring for a client with a closed skull injury who has an intracranial pressure (ICP) reading consistently over 20 mmHg, According to the MonroeKellie Doctrine, If Intracranial pressure continues to Increase, what will occur? Select All that Apply.
Correct Answer: B,C,D
Rationale: Increased ICP leads to ischemia due to reduced cerebral perfusion, hypotension as a late compensatory mechanism, and hyperventilation as a respiratory response to acidosis.
Question 5 of 5
A nurse is providing education to a group of older adults about the risk of stroke. Which selections made by the group indicate an understanding of the teaching? Select All that Apply
Correct Answer: A,E
Rationale: Recognizing stroke symptoms (face, arm, speech changes) and lifestyle modifications (low sodium, limited alcohol, regular exercise) are correct stroke prevention strategies.