ATI RN
ATI n300 Med Surg Exam Questions
Extract:
Question 1 of 5
The nurse is caring for a patient with muffled heart sounds, jugular venous distention and hypotension. The provider diagnoses the patient with cardiac tamponade. The nurse understands that the priority of treatment for this type of shock is
Correct Answer: A
Rationale: Pericardiocentesis to remove fluid from the pericardium is the definitive treatment for cardiac tamponade.
Question 2 of 5
A heparin IV bolus is ordered: 80 units per kilogram. The unit's pharmacist prepares & labels a dose of heparin that is 5600 units. What is the patient's weight in kilograms?
Correct Answer: A
Rationale: 5600 units ÷ 80 units/kg = 70 kg.
Question 3 of 5
The nurse is caring for a client who received a blunt force injury to zone II of the neck. Which assessment finding should the nurse report to the physician IMMEDIATELY?
Correct Answer: C
Rationale: Dysphonia or dysphagia indicate airway compromise, requiring immediate attention.
Question 4 of 5
For the nurse to correctly classify the severity of a burn injury of a client, what must be assessed? (Select All that Apply.)
Correct Answer: A,B,C,D
Rationale: Causative agent, depth, location, and TBSA are critical for assessing burn severity.
Question 5 of 5
A client who has sustained blunt abdominal trauma is admitted to the ICU. Upon assessment the nurse notices the following vital signs: T-99F; HR- 148: RR-38; B/P-60/40. The client is diaphoretic and restless. The following selections are approved by the ICU physician. What would be the PRIORITY nurse's action?
Correct Answer: D
Rationale: The client is in hypovolemic shock due to suspected internal bleeding. Lowering the head of the bed improves cerebral perfusion, increasing IV fluids restores intravascular volume, and checking pulse oximetry ensures adequate oxygenation. This is the priority action to stabilize the client.