ATI RN
ATI Med Surg Exam 9 Questions
Extract:
Question 1 of 5
The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence?
Correct Answer: A
Rationale: Sweating and pallor are early signs and symptoms of dumping syndrome, which is a condition where food moves too quickly from the stomach to the small intestine, causing rapid fluid shifts and hormonal changes. Sweating and pallor are caused by hypoglycemia, which occurs when the high concentration of food in the small intestine stimulates insulin secretion. Abdominal cramping and pain are late signs and symptoms of dumping syndrome, which occur about one to three hours after eating. Abdominal cramping and pain are caused by intestinal distension, spasms, and gas formation. Double vision and chest pain are not signs and symptoms of dumping syndrome, but may indicate other serious conditions, such as stroke or heart attack. Double vision and chest pain should be reported to the provider immediately. Bradycardia and indigestion are not signs and symptoms of dumping syndrome, but may be related to other gastrointestinal disorders, such as gastritis or peptic ulcer disease. Bradycardia and indigestion should be evaluated by the provider for further diagnosis and treatment.
Question 2 of 5
A nurse collects health history from a 65 year old client. Which of the following risk factors in the client's history puts the client at the highest risk for embolic stroke?
Correct Answer: A
Rationale: Atrial fibrillation increases the risk of embolic stroke by causing blood pooling in the heart, leading to clot formation that can travel to the brain and block an artery.
Question 3 of 5
A nurse is admitting a client who has a partial hearing loss. Which of the following is the priority action by the nurse?
Correct Answer: D
Rationale: Reason: This is incorrect because standing directly in front of the client is not the priority action by the nurse when admitting a client who has a partial hearing loss. Standing directly in front of the client can enhance communication, but it is not as important as assessing the client's hearing status and needs. Reason: This is incorrect because rephrasing statements the client does not hear is not the priority action by the nurse when admitting a client who has a partial hearing loss. Rephrasing statements can improve understanding, but it is not as essential as evaluating the client's hearing level and preferences. Reason: This is incorrect because speaking using his usual tone of voice is not the priority action by the nurse when admitting a client who has a partial hearing loss. Speaking using his usual tone of voice may or may not be appropriate, depending on the client's hearing ability and comfort. The nurse should adjust his tone of voice based on the client's feedback and response. Reason: This is the correct choice because determining if the client uses hearing aids is the priority action by the nurse when admitting a client who has a partial hearing loss. Hearing aids are devices that amplify sound and improve hearing for people with hearing loss. The nurse should determine if the client uses hearing aids, and if so, check their function, fit, and battery life. The nurse should also ask about any other assistive devices or strategies that the client uses to communicate effectively.
Question 4 of 5
A client receiving parenteral nutrition by central venous access reports feeling unwell. The nurse assesses the client and suspects that the central line has become infected. Which of the following findings indicate that the client has developed a systemic infection? Select all that apply.
Correct Answer: B,E,F
Rationale: Purulent drainage, leukocytosis, and fever indicate a systemic infection, as they reflect bacterial invasion and immune response spreading beyond the local site.
Question 5 of 5
A nurse reviewing a client's chart reads that the client was observed having a complex partial seizure with automatisms of the face. What does the nurse understand this to mean?
Correct Answer: D
Rationale: Complex partial seizures involve focal brain activity with impaired awareness, and automatisms like lip-smacking are involuntary facial movements (
Choice
D). Losing bladder control is typical of generalized tonic-clonic seizures (
Choice
A). Fixed, dilated eyes are not specific to complex partial seizures (
Choice
B). Involuntary groaning is less characteristic than facial automatisms (
Choice
C).