ATI RN
ATI Med Surg Nurs 300 Day Exam 4 Questions
Extract:
Question 1 of 5
The nurse is analyzing a client's arterial blood gas (ABG) values with the following results: pH 7.44, PaCO2 30 mmHg, Pa02 90 mmHg, and HCO3 18mEg/L. Which acid base Imbalance should the nurse associate with these results?
Correct Answer: B
Rationale: Normal pH (7.44), low HCO3 (18 mEq/L), and low PaCO2 (30 mmHg) indicate partially compensated metabolic acidosis with respiratory compensation.
Question 2 of 5
The nurse is admitting a client who is on a ventilator. The client has a medical diagnosis of acute respiratory distress syndrome (ARDS). Which infection control guideline is of greatest importance?
Correct Answer: A
Rationale: Hand hygiene is the most critical infection control measure to prevent ventilator-associated infections in ARDS patients.
Question 3 of 5
To achieve the outcome of effective ventilation, which nursing intervention should be included in the plan of care for a client on a ventilator?
Correct Answer: A
Rationale: Suctioning as needed clears airway secretions, ensuring effective ventilation in ventilated clients.
Question 4 of 5
The client tells the nurse, 'My physician told me that I had a non-ST elevation myocardial infarction (NSTEMI). ' I thought all heart attacks were the same. Can you explain this to me?' The nurse's best response to the client's question would be: 'NSTEMI is
Correct Answer: D
Rationale: NSTEMI involves partial coronary blockage and is less severe than STEMI, which involves full blockage and ST elevation on ECG.
Question 5 of 5
The nurse is to begin a nitroglycerin infusion for a client diagnosed with an anterior wall myocardial infarction. Which assessment finding should the nurse report to the provider immediately?
Correct Answer: D
Rationale: A blood pressure of 90/50 mmHg is significantly low and could indicate hypotension, a known side effect of nitroglycerin infusion. This can compromise perfusion to vital organs and may require adjustment or discontinuation of the infusion, making it the most urgent finding to report.