ATI RN
ATI Advanced Med Surg Exam 3 Questions
Extract:
Question 1 of 5
Which action should the nurse take first when the low pressure alarm sounds for a patient who has an arterial line in the left radial artery?
Correct Answer: B
Rationale: Checking for pallor assesses perfusion distal to the arterial line, identifying potential occlusion or complications causing the alarm.
Question 2 of 5
A nurse is monitoring a client who is receiving a unit of packed RBCs following surgery. Which of the following assessments is an indication that the client might be experiencing circulatory overload?
Correct Answer: C
Rationale: Dyspnea indicates pulmonary congestion from circulatory overload, a common complication of rapid blood transfusion.
Question 3 of 5
A nurse is caring for a client who is in the compensatory stage of shock. Which of the following findings should the nurse expect?
Correct Answer: B
Rationale: Tachycardia (e.g., 160/min) is a compensatory mechanism in shock to maintain cardiac output and perfusion.
Extract:
Nurse's Notes
Client came to the ER for increase SOB worsening dyspnea and restlessness. Respiratory rate is currently 32/min with shallow breath BP 198/78 mm Hg. Oxygen has been increased from 2 L nasal cannula to 50% face mask with little improvement of oxygen saturation. Current oxygen saturation is 91% on 50% facemask. Arterial blood gases drawn and sent to lab.
Diagnostic Results
ABGS:
pH 7.25 (7.35 to 7.45)
pCO2 62 mm Hg (35 to 45 mm Hg)
HCO3-22 mEq/L (22 to 26 mEq/L)
Question 4 of 5
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
Correct Answer:
Rationale:
Extract:
Question 5 of 5
When admitting a patient with possible respiratory failure and a high PaCO2, which assessment information should be immediately reported to the health care provider?
Correct Answer: B
Rationale: Somnolence indicates potential respiratory depression or hypercapnia, a critical sign of worsening respiratory failure requiring immediate reporting.