ATI RN
ATI EW N300 Med Surg Exam Questions
Extract:
Question 1 of 5
The nurse recognizes that teaching a client to wash the hands after using the bathroom is an attempt to break the chain of infection between the:
Correct Answer: B
Rationale: Handwashing interrupts the mode of transmission, preventing pathogens from reaching a portal of entry.
Question 2 of 5
The nurse has established a goal to maintain intracranial pressure (ICP) within the normal range for a patient with an acute head injury. Which actions should the nurse take to achieve this goal?
Correct Answer: A,B,D
Rationale: Elevating the head of the bed aids venous drainage, serial assessments monitor ICP changes, and sedatives/pain medications reduce cerebral metabolic rate, all helping maintain normal ICP.
Question 3 of 5
The nurse is caring for a patient with an acute brain injury. Which of the following sets of vital signs would concern the nurse about increasing intracranial pressure (ICP)?
Correct Answer: A
Rationale: High systolic BP, bradycardia, and low respiratory rate suggest Cushing's triad, indicative of increased ICP.
Question 4 of 5
The nurse recognizes that teaching a client to wash the hands after using the bathroom is an attempt to break the chain of infection between the:
Correct Answer: B
Rationale: Handwashing interrupts the mode of transmission, preventing pathogens from reaching a portal of entry.
Question 5 of 5
A nurse is assessing a previously alert client who has now become confused, lethargic, and does not follow commands appropriately. The blood glucose measures 48 mg/dL. What is the appropriate nursing intervention?
Correct Answer: C
Rationale: Dextrose 50% IV push rapidly raises blood glucose in symptomatic, confused patients, bypassing the gastrointestinal tract for immediate action.