ATI RN
ATI n300 Med Surg Exam Questions
Extract:
Question 1 of 5
The nurse is caring for a patient with major burns Total Body Surface Area (TBSA) of 63%. The nurse understands that this patient is at the highest risk for the combination of which types of shock? (Select All that Apply.)
Correct Answer: A,D
Rationale: Severe burns cause hypovolemic shock from fluid loss and distributive shock from systemic inflammatory response syndrome (SIRS).
Question 2 of 5
The nurse caring for a client with severe sepsis suspects the client may be developing disseminated intravascular coagulation (DIC). Which of the following signs and symptoms would support the diagnosis of DIC?
Correct Answer: C
Rationale: Oozing blood from IV sites is a classic sign of DIC due to excessive clotting followed by bleeding.
Question 3 of 5
A client with hypovolemic shock who did not respond to fluid resuscitation is started on norepinephrine. What is the desired outcome?
Correct Answer: C
Rationale: A MAP of at least 65 mmHg ensures adequate perfusion of vital organs, the primary goal of norepinephrine therapy.
Question 4 of 5
A patient is ordered a heparin infusion at 1200 units/hour. Historically, IV heparin is premixed as 25,000 units of heparin in 250 mL NSS at the institution. Nurse A starts the infusion at 12 mL/hr at 1700. The nurse asks their colleague to cosign the infusion for a prescribed rate change at 1900. Nurse B reminds Nurse A that there has been a recent pharmacy policy change. The IV heparin that the patient is currently receiving is 50,000 units in 250 mL in NSS. Which of the following action(s)/statement(s) are accurate in this scenario? (Select All that Apply.)
Correct Answer: C,E,F
Rationale: A medication error occurred, the patient received an overdose, and the overdose amount is correctly calculated as 3200 units.
Question 5 of 5
The client who is experiencing septic shock is started on norepinephrine by intravenous drip via pump. Which frequent assessments should the nurse prioritize while administering this medication? (Select All that Apply)
Correct Answer: C,D,E
Rationale: Norepinephrine is a vasopressor requiring frequent monitoring of the IV site to prevent extravasation, blood pressure and heart rate to assess therapeutic effect, and hourly urine output to evaluate organ perfusion.