ATI RN
ATI Med Surg Nursing 300 Final Exam Questions
Extract:
Question 1 of 5
The nurse assesses the patient with a spinal cord injury at the level C-7 and finds warm, flushed skin with profuse sweating above the level of injury, and pale, cold skin below the level of injury. The patient is bradycardic, but severely hypertensive. What are the priority nursing interventions?
Correct Answer: B
Rationale: Symptoms indicate autonomic dysreflexia, requiring assessment for noxious stimuli (e.g., bladder distension) and anticipation of antihypertensives to manage severe hypertension.
Question 2 of 5
The nurse is caring for client who is four days post-operative open repair of an abdominal aortic aneurysm the abdomen is distended. The client is complaining abdominal pain and the abdomen is distended. What action should the nurse take at this time?
Correct Answer: B
Rationale: Abdominal pain and distension post-AAA repair suggest complications like bleeding or ischemia, requiring immediate provider notification and testing.
Question 3 of 5
The nurse is caring for a client with infectious endocarditis. Which information obtained from the health history could have contributed to the development of the disease progress?
Correct Answer: C
Rationale: Intravenous substance use is a major risk factor for infectious endocarditis due to the introduction of bacteria into the bloodstream via non-sterile needles, leading to valve infection.
Question 4 of 5
The nurse is caring for a client who is receiving mechanical ventilation. Which action should the nurse take to prevent ventilator-associated pneumonia?
Correct Answer: B
Rationale: Regular oral care reduces oral bacteria, decreasing the risk of ventilator-associated pneumonia.
Question 5 of 5
A nurse is assessing a client who has mitral valve stenosis Which of the following findings should the nurse except?
Correct Answer: B
Rationale: Mitral valve stenosis causes a diastolic heart murmur due to turbulent blood flow from the left atrium to the ventricle. Clubbing is linked to hypoxia, barrel chest to COPD, and bradycardia is not typical.