ATI RN
Medical Surgical Respiratory 3
1. A nurse in a provider's office is assessing a client. Which of the following findings is not a manifestation of pulmonary tuberculosis?
- A. Night sweats
- B. Low-grade fever
- C. Weight gain
- D. Blood in the sputum
Correct answer: C
Rationale:
2. A client is moving to a new state and needs to find a new doctor and hospital there. What advice by the nurse is best?
- A. Ask the hospitals there about standard nurse-client ratios.
- B. Choose the hospital that has the newest technology.
- C. Find a hospital that is accredited by The Joint Commission.
- D. Use a facility affiliated with a medical or nursing school.
Correct answer: C
Rationale: Choosing a hospital accredited by The Joint Commission (TJC) or another accrediting body is the best advice as it ensures a focus on safety and quality standards.
3. A client with heart failure has gained 2 kg (4.4 lbs) in the past 24 hours. What action should the nurse take first?
- A. Restrict the client's fluid intake.
- B. Assess the client's respiratory status.
- C. Administer diuretics as ordered.
- D. Notify the healthcare provider.
Correct answer: B
Rationale: Assessing the client's respiratory status is the priority as it helps determine if the weight gain is due to fluid retention affecting breathing. This assessment is crucial in addressing the immediate concern of potential respiratory distress before implementing interventions like fluid restriction, diuretics, or notifying the healthcare provider.
4. A client has been diagnosed with hypertension but does not take the antihypertensive medications because of a lack of symptoms. What response by the nurse is best?
- A. Do you have trouble affording your medications?
- B. Most people with hypertension do not have symptoms.
- C. You are lucky; most people get severe morning headaches.
- D. You need to take your medicine or you will get kidney failure.
Correct answer: B
Rationale: Most people with hypertension are asymptomatic, although a small percentage do have symptoms such as headache. The nurse should explain this to the client. Asking about paying for medications is not related because the client has already admitted nonadherence. Threatening the client with possible complications will not increase compliance.
5. A healthcare professional is caring for a client who has just developed a pulmonary embolism. Which of the following medications should the healthcare professional anticipate administering?
- A. Furosemide
- B. Dexamethasone
- C. Heparin
- D. Atropine
Correct answer: C
Rationale: In the scenario of a pulmonary embolism, the priority medication to administer is Heparin. Heparin is an anticoagulant that helps prevent the formation of new blood clots and the growth of existing ones, which is crucial in managing pulmonary embolism. Furosemide is a diuretic used to treat fluid retention, Dexamethasone is a corticosteroid used for inflammation, and Atropine is an anticholinergic medication used for various purposes such as treating bradycardia.
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