ATI RN
ATI Nur 221 Med Surg Exam Cardiac Questions
Extract:
Question 1 of 5
The nurse is assessing the client diagnosed with COPD. Which of the following would require immediate attention by the nurse?
Correct Answer: D
Rationale: Oxygen flowmeter set on 8 LPM is correct. High-flow oxygen can suppress the hypoxic drive in COPD clients, leading to respiratory depression. The nurse should immediately lower the oxygen to a safer level (typically 1-3 LPM) and monitor the client's respiratory status. Use of accessory muscles, thick white sputum, and barrel chest with clubbing are common in COPD but do not require immediate intervention compared to high oxygen flow.
Extract:
Nurses Notes
Client presents to the ED with substernal chest pain that comes and goes. The client states that the pain has been occurring for the last 8 hr. The pain, at times radiates down the left arm. Client also reports intermittent nausea
Client appears pale and slightly diaphoretic. Client rates current pain as 7 on a scale of 0 to 10
Question 2 of 5
Client presents to the ED with substernal chest pain that comes and goes. The client states that the pain has been occurring for the last 8 hr. The pain, at times radiates down the left arm. Client also reports intermittent nausea Client appears pale and slightly diaphoretic. Client rates current pain as 7 on a scale of 0 to 10. A nurse is caring for a client in the emergency department (ED). The nurse is planning care for the client. For each potential prescription. indicate whether it is indicated, nonessential, or contraindicated.
| Options | Non- Anticipated | Essential | Contraindicated |
|---|---|---|---|
| Obtain intravenous (IV) access | |||
| Obtain the client's family history | |||
| Apply continuous ECG monitoring | |||
| Administer Oâ‚‚ to maintain oxygen saturation greater than 90% |
Correct Answer: A,C,D
Rationale: Obtain intravenous (IV) access (
A), apply continuous ECG monitoring (
C), and administer Oâ‚‚ if saturation is below 90% (
D) are indicated for suspected MI. Obtaining family history (
B) is nonessential in the acute phase.
Extract:
Question 3 of 5
A client with a history of heart failure on daily weights has a 2-pound weight gain and pitting edema in bilateral lower extremities. Which action should the nurse take next?
Correct Answer: C
Rationale: Performing a head-to-toe assessment, including vital signs, is correct. A 2-pound weight gain and edema suggest fluid retention, requiring assessment for worsening heart failure symptoms like crackles or respiratory distress. Encouraging fluid intake, monitoring without action, or checking code status are not immediate priorities.
Question 4 of 5
A client has chronic obstructive pulmonary disease (COPD) and right-sided heart failure. Which statement by the nurse is correct?
Correct Answer: A
Rationale: Eating six small meals a day limits oxygen demand during digestion and prevents bloating, aiding breathing. Excessive fluids, lying down, and protein intake adjustments are not appropriate.
Question 5 of 5
The nurse is providing care for a client admitted to rule out a myocardial infarction who is experiencing chest pain while walking to the bathroom. Which action should the nurse implement first?
Correct Answer: B
Rationale: Having the client sit down immediately is correct. Stopping activity reduces cardiac workload and oxygen demand, preventing further ischemia. Other actions follow after ensuring the client is seated.