ATI RN
ATI Med Surg Nurs 300 Day Exam 4 Questions
Extract:
Question 1 of 5
The nurse is caring for a client three hours after percutaneous coronary intervention (PCI) with stent placement. The client now complains of 5/10 chest pain. The client is visibly diaphoretic and anxious. The ECG shows ST segment elevations. The vital signs are as follows: BP: 156/82, HR: 110, RR: 20, T: 98.6, and Sp02: 94% on 2L nasal canula. The nurse anticipates which intervention in this situation?
Correct Answer: D
Rationale: Chest pain with ST elevations post-PCI suggests reocclusion, requiring repeat PCI to restore coronary blood flow.
Question 2 of 5
The nurse is caring for a client receiving mechanical ventilation. The nurse hears the low-pressure alarm sound. After checking the client and ventilator, the nurse cannot determine the source of the alarm. What should the nurse do next?
Correct Answer: D
Rationale: Using a manual resuscitation bag ensures continued ventilation while investigating the low-pressure alarm, prioritizing client oxygenation.
Question 3 of 5
The nurse is caring for the client experiencing Guillain-Barre syndrome (GBS). It is most important for the nurse to monitor the client for which complication?
Correct Answer: C
Rationale: Respiratory failure is the most life-threatening complication in GBS due to paralysis affecting breathing muscles.
Question 4 of 5
The nurse is reviewing the arterial blood gas (ABG) result for a client currently on a 100% non-rebreather mask. The nurse is able to interpret which of the following results as hypoxemic respiratory failure?
Correct Answer: A
Rationale: PaO2 of 44 mmHg and O2 saturation of 76% despite 100% oxygen indicate hypoxemic respiratory failure, characterized by severe hypoxemia.
Question 5 of 5
The nurse is caring for a client diagnosed with acute respiratory failure. The client now requires ventilator support. What is the goal of treatment at this time? A/An:
Correct Answer: C
Rationale: The primary goal in acute respiratory failure is to maintain adequate oxygenation, with a target O2 saturation of at least 94%.