ATI RN
ATI Custom Medical Surgical Nurse Exam 2 Questions
Extract:
Question 1 of 5
While collecting data from a client who has a cast on his right leg, a nurse locates an area on the cast that feels warm to the touch. Which of the following findings should the nurse identify as a complication to the client's condition?
Correct Answer: B
Rationale: A warm area on the cast suggests an underlying infection due to increased blood flow as the body fights the infection. Uneven cast drying, pressure, or poor circulation do not typically cause warmth.
Question 2 of 5
A nurse is collecting data from a client who fell at home and reported a brief loss of consciousness. Which of the following findings should the nurse immediately report to the charge nurse?
Correct Answer: D
Rationale: Clear fluid in the ear may indicate a cerebrospinal fluid leak, a serious complication of head injury requiring immediate attention. Bruising, disorientation, and tachycardia, while concerning, are less urgent.
Question 3 of 5
A nurse is collecting data from a client who has a short arm cast for a fractured wrist. Which of the following findings indicates impaired venous return in the affected arm?
Correct Answer: B
Rationale: A bounding distal pulse suggests impaired venous return, indicating blood is not returning properly from the arm. Wheezing, fever, and pain have other causes.
Question 4 of 5
A nurse is assisting with the development of a plan of care for an older adult who is at risk for falls. Which of the following actions should the nurse contribute to the plan? (Select all that apply)
Correct Answer: C,D,E
Rationale: Night lights improve visibility, a reachable bedside table reduces unnecessary movement, and locked wheels ensure stability, all reducing fall risk. Sedatives and bed height do not directly prevent falls.
Question 5 of 5
A nurse in the emergency department is assisting with the care of a client who has myasthenia gravis and is in crisis. The nurse should identify which of the following factors can cause a myasthenic crisis.
Correct Answer: B
Rationale: A respiratory infection can exacerbate myasthenia gravis symptoms, triggering a myasthenic crisis with severe breathing and swallowing difficulties. Overmedication, insufficient sleep, or exercise do not typically cause a crisis.