ATI RN
ATI Nur285 Med Surg Fall Exam Questions
Extract:
Question 1 of 5
Which of the following statements about strictureplasty is correct?
Correct Answer: D
Rationale: Strictureplasty is a surgical procedure used in Crohn's disease to widen narrowed intestinal areas, preserving intestinal function.
Question 2 of 5
The nurse is caring for a client who has had an upper G.I. endoscopy. The client's vital signs must be taken every 30 minutes for two hours after the procedure. The nurse assigns an unlicensed assistant to take the vital signs. Two hours later, the assistant reports to client who was previously afebrile has now developed a temperature of 101.8°F. What should the nurse do in response to this reported data by the unlicensed assistant?
Correct Answer: A
Rationale: A fever following an upper gastrointestinal endoscopy can be a sign of a serious complication, such as perforation, which could cause peritonitis. The nurse should promptly assess the client for other signs of perforation, such as abdominal pain, rigidity, or changes in vital signs.
Extract:
Nurse's Notes: Day 1, 1530: Client appears restless. SaO2 92% on 40% humidified oxygen via tracheostomy collar. Lung fields with scattered rhonchi throughout. Tracheostomy suctioned for thin clear secretions. Day 1, 1545: Client appears less anxious. SaO2 98% on 40% humidified oxygen via tracheostomy collar. Breath sounds clear throughout. Day 3, 1530: Client appears restless. Buccal mucosa dusky. SaO2 88% on 40% humidified oxygen via tracheostomy collar. Lung fields with coarse crackles, diminished at right lower lobe. Tracheostomy suctioned for thick yellow secretions. Day 3, 1545: Client continues to appear restless. SaO2 94% on 40% humidified oxygen via tracheostomy collar. Breath sounds with intermittent crackles, diminished at right lower lobe. Vital Signs: Day 1, 1530: Temperature 36.9° C (98.5° F), Heart rate 100/min, Respiratory rate 22/min, Blood pressure 124/74 mm Hg, SaO2 92 % on 40% humidified oxygen. Day 3, 1530: Temperature 39.4° C (103° F), Heart rate 106/min, Respiratory rate 24/min, Blood pressure 128/76 mm Hg, SaO2 88% on 40% humidified oxygen. Diagnostic Results: Chest x-ray: right lower lobe opacity.
Question 3 of 5
A nurse is caring for a client who has a tracheostomy. Drag words from the choices below to fill in each blank in the following sentence. The client has manifestations of..... and....
Correct Answer: B,D
Rationale: Fever, decreased oxygen saturation, crackles, and chest x-ray opacity indicate pneumonia; low SaO2 and respiratory distress suggest hypoxia.
Extract:
Question 4 of 5
A client is admitted to the hospital after vomiting bright red blood and is diagnosed with a bleeding duodenal ulcer. The client develops a sudden, sharp pain in the mid epigastric region along with a rigid, board-like abdomen. These clinical manifestations are most likely indicative of which of the following?
Correct Answer: D
Rationale: Sudden, sharp pain and a rigid, board-like abdomen indicate a perforated ulcer, causing peritonitis, a medical emergency requiring immediate intervention.
Question 5 of 5
A patient has a nasogastric (NG) tube following esophagectomy. Following standards of practice, which of the following postoperative instructions should the nurse question the surgeon about?
Correct Answer: C
Rationale: A temperature under 100.5°F is not typically concerning post-surgery, so notifying the physician for this is unnecessary.