ATI RN
ATI n200 Med Surg Exam Questions
Extract:
Question 1 of 5
The most effective way for a nurse to avoid a lumbosacral spine injury while caring for clients is to:
Correct Answer: D
Rationale: Protective back supports can be helpful but do not replace the need for proper body mechanics and lifting devices. Proper footwear is important for overall safety but does not directly prevent back injuries related to lifting. Staying in good physical shape helps with overall body strength and endurance but does not eliminate the risk of injury when lifting clients. Mechanical lifting devices are the most effective way to prevent injury while moving or lifting patients, as they reduce the risk of strain on the spine.
Question 2 of 5
A client who receives an antihypertensive medication daily is NPO except medications for surgery. The most recent blood pressure recording is 174/88. What action should the nurse take first?
Correct Answer: D
Rationale: Administering antihypertensive (
D) addresses high blood pressure. Notifying (
A), documenting (
B), and relaxation (
C) are secondary.
Question 3 of 5
The nurse is giving medications using the client's feeding tube. Which medication cannot be delivered in this way?
Correct Answer: A
Rationale: Nifedipine XL (extended-release) should not be crushed as it alters the medication release mechanism. Diltiazem can be given via a feeding tube if it is in an appropriate form. Acetaminophen is available in a form suitable for feeding tubes. Furosemide can be administered via a feeding tube.
Question 4 of 5
The nurse is attempting to assist a cognitively-impaired adult to maintain bladder continence. Which intervention is most appropriate?
Correct Answer: B
Rationale: Incontinence briefs are appropriate for overnight use but do not encourage independence in bladder management during the day. Providing easy-to-remove clothing is a practical intervention that enhances the client's independence in managing toileting, especially if they have cognitive impairments. It ensures that the client can quickly respond to the urge to urinate. Explaining the use of a call bell is helpful but may not be the most appropriate approach for a cognitively-impaired client who may forget or struggle with communication. Asking the client every two hours if they need to urinate is helpful but may not be as effective as providing easy access to clothing for quick toileting.
Question 5 of 5
A client has undergone a laminectomy and diskectomy at L3-4 and L4-5 with spinal fusion at those levels. Postoperatively the nurse would expect to include in the client's care which of the following?
Correct Answer: D
Rationale: A Foley catheter is used postoperatively if the client is unable to void, but its use should be temporary, not for ease of elimination long-term. A cane may be needed for ambulation after recovery, but immediately postoperatively, focus is on spinal stability. Heat application is generally not recommended immediately after spinal surgery, as it could increase swelling and inflammation. A back brace helps maintain spinal stability and prevents excessive movement that could disrupt the healing process after spinal fusion surgery.