ATI RN
ATI RN Adult Medical Surgical 2023 Questions Correct Answers Questions
Extract:
A client reports after eating breakfast this morning 0630hrs that they began feeling a tightness in the chest that radiates to the left arm. History: Hyperlipidemea, Hpertension, type 2 diabetes mellitus, Non- smoker, Denies use of alcohol or recreational drug abuse.
Time: 1000hrs Temperature, Heart Rate, Respiratory Rate, Blood Pressure, Oxygen Saturation 1000 37.1°C (98.8°F) 110/min (irregular) 24/min 164/80 mmHg 93% on room air 1015 36.7°C (98.2°F) 120/min (irregular) 22/min 176/82 mmHg 89% on room air. Time: 1015hrs Temperature, Heart Rate, Respiratory Rate, Blood Pressure,Oxygen Saturation 1000 37.1°C (98.8°F) 110/min (irregular) 24/min 164/80 mmHg 1015 36.7°C (98.2°F) 120/min (irregular) 22/min 176/82 mmHg 89% on room air 1200 36.7°C (98.2°F)
Question 1 of 5
Which of the following actions should the nurse take? (Select all that apply)
Correct Answer: A, B, D,E
Rationale: The correct actions for the nurse to take are A, B, D, and E. A - anticipating client prep for cardiac catheterization is important for timely intervention. B - assisting with a continuous heparin infusion helps prevent blood clot formation during the procedure. D - anticipating an increase in metoprolol dosage is necessary to manage cardiac workload during the procedure. E - obtaining a prescription for NPO status is crucial to prevent complications during the procedure.
Choices C (encouraging ambulation) and F (requesting an antibiotic prescription) are not directly related to preparing for cardiac catheterization and may not be necessary in this context.
Extract:
Question 2 of 5
A nurse is caring for a client who has a small bowel obstruction and an NG tube in place. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Maintain low intermittent suction. This is because in a small bowel obstruction, the NG tube helps decompress the bowel by removing gastric contents and relieving pressure. Low intermittent suction helps prevent excessive suction which can cause tissue damage.
Clamping the NG tube every 2 hours (choice
B) is incorrect as it will prevent the tube from effectively decompressing the bowel. Removing the NG tube immediately (choice
C) is also incorrect as it is needed for decompression. Encouraging high-fiber foods (choice
D) is contraindicated as they can worsen the obstruction.
Question 3 of 5
A nurse is providing teaching to a client who is scheduled for a bronchoscopy. Which of the following statements should the nurse include in the teaching?
Correct Answer: A
Rationale:
Correct Answer: A
Rationale: The nurse should include the statement "You will not be able to eat or drink after the procedure until you are able to cough" because it is essential for the client's safety to prevent aspiration. After a bronchoscopy, the client may have an impaired gag reflex from the procedure, increasing the risk of choking.
Therefore, it is crucial to wait until the gag reflex returns before eating or drinking. This statement emphasizes the importance of airway protection post-procedure.
Summary:
B: Incorrect - Breathing during a bronchoscopy is usually done through the mouth.
C: Incorrect - Bronchoscopy is uncomfortable but not typically painful due to sedation.
D: Incorrect - Sedation is commonly used during bronchoscopy to ensure client comfort.
E: Incorrect - Bed rest after a bronchoscopy is not typically necessary unless complications arise.
Question 4 of 5
A nurse is teaching a client who has left-sided weakness how to use a quad cane. Which of the following client actions indicates an understanding of the teaching?
Correct Answer: B
Rationale: The correct answer is B. Advancing the weaker leg forward to the cane provides stability and support, helping distribute weight evenly and preventing falls. This step is crucial in using a quad cane effectively. Moving the cane too far ahead (
A) could cause imbalance. Taking a step with the stronger leg first (
C) would not provide the needed support for the weaker side. Holding the cane with the same side as the weakness (
D) may not provide the necessary support. It is essential to prioritize stability and weight distribution, making option B the correct choice.
Question 5 of 5
A nurse is assessing a client who has right-sided heart failure. Which of the following findings should the nurse identify as a manifestation of right-sided heart failure?
Correct Answer: B
Rationale: The correct answer is B: Increased abdominal girth. In right-sided heart failure, the heart is unable to effectively pump blood to the lungs for oxygenation, causing blood to back up into the systemic circulation. This leads to fluid retention, particularly in the lower extremities and abdomen, resulting in increased abdominal girth. Crackles in the lungs (
A) are indicative of left-sided heart failure due to pulmonary congestion. Pink frothy sputum (
C) is associated with pulmonary edema, a sign of left-sided heart failure. Hypertension (
D) is not typically associated with right-sided heart failure, as it is more commonly seen in conditions like systemic hypertension.