ATI RN
ATI Med Surg Exam 1 2024 Questions
Extract:
Question 1 of 5
The spouse of an older client experiencing delirium is at the client's bedside. The nurse is providing an update to the spouse regarding the client's plan of care. Which of the following responses by the spouse indicates a need for further teaching?
Correct Answer: C
Rationale: The spouse's belief that delirium is a normal part of aging indicates a misunderstanding. Delirium is not a typical aging process and may signal serious underlying conditions requiring assessment and intervention.
Question 2 of 5
A nurse is planning care for a client who has peripheral venous disease. Which of the following interventions should the nurse include in the plan of care?
Correct Answer: A,C,D,E
Rationale: A. Intermittent pneumatic compression pumps improve circulation by promoting venous return, reducing edema. C. Layered wraps, like compression bandages, can manage venous insufficiency in some cases of peripheral venous disease. D. Elevating legs reduces edema and improves venous return by aiding blood flow back to the heart. E. Exercise, such as walking, promotes venous return and reduces venous stasis.
Question 3 of 5
A nurse is caring for a client who has Meniere's disease. The nurse identifies that which of the following manifestations is caused by an excessive accumulation of endolymph fluid?
Correct Answer: B
Rationale: Vertigo is a hallmark symptom of Meniere's disease and is caused by an excessive accumulation of endolymph fluid in the inner ear. Vertigo presents as a sensation of spinning or dizziness, often accompanied by nausea, vomiting, and imbalance.
Question 4 of 5
A nurse is preparing a plan of care for a client who is postoperative following a cochlear implant insertion. Which of the following instructions should the nurse include in the plan of care?
Correct Answer: D
Rationale: After cochlear implant insertion, it is important to keep the surgical site clean to prevent infection. Washing the hair 24 hours after surgery helps to maintain cleanliness and hygiene without disrupting the surgical site. It is typically safe to wash the hair after this period as long as gentle care is taken to avoid excessive manipulation of the implant site.
Question 5 of 5
A nurse is caring for a client in the intensive care unit. Which of the following laboratory values could contribute to an episode of delirium?
Correct Answer: D
Rationale: Elevated blood glucose levels (254 mg/dL) can lead to alterations in cerebral metabolism, neuronal dysfunction, and impaired cognitive function, predisposing individuals to delirium.