ATI RN
ATI Detailed Answer Key Medical Surgical
1. A nurse in an emergency room is caring for a client who sustained partial-thickness burns to both lower legs, chest, face, and both forearms. Which of the following is the priority action the nurse should take?
- A. Insert an indwelling urinary catheter.
- B. Inspect the mouth for signs of inhalation injuries.
- C. Administer intravenous pain medication.
- D. Draw blood for a complete blood cell (CBC) count.
Correct answer: B
Rationale: When caring for a client with burns, especially burns to the face and chest, the priority action for the nurse is to inspect the mouth for signs of inhalation injuries. Inhalation injuries can be life-threatening and may not be immediately apparent. Identifying these injuries early allows for prompt intervention and can significantly impact the client's outcomes. While other actions such as pain management and blood tests are important, assessing for inhalation injuries takes precedence due to its critical nature.
2. A client is prescribed prednisone for asthma management. Which statement by the client indicates a need for further teaching?
- A. I will take this medication every day to prevent asthma attacks.
- B. I will avoid people with infections while taking this medication.
- C. I will take this medication with food to prevent stomach upset.
- D. I will stop taking this medication if I feel fine.
Correct answer: D
Rationale: The correct answer is D because prednisone, a corticosteroid, should not be abruptly stopped. It must be tapered off gradually to prevent adrenal insufficiency. Choices A, B, and C demonstrate proper understanding of the medication's use and side effects, emphasizing the importance of daily intake, infection prevention, and taking it with food to avoid stomach upset.
3. A healthcare professional is assessing a client with rheumatoid arthritis. Which assessment finding is most characteristic of this disease?
- A. Asymmetrical joint involvement
- B. Heberden's nodes
- C. Morning stiffness lasting more than 30 minutes
- D. Pain that worsens with activity
Correct answer: C
Rationale: Morning stiffness lasting more than 30 minutes is a hallmark symptom of rheumatoid arthritis. This prolonged morning stiffness is typically a distinguishing feature of rheumatoid arthritis compared to other types of arthritis, making it the most characteristic assessment finding for this disease.
4. When caring for a client with Alzheimer's disease, what is the most appropriate communication technique for a nurse to use?
- A. Providing detailed explanations
- B. Speaking in a loud and clear voice
- C. Using simple and direct statements
- D. Offering multiple choices to the client
Correct answer: C
Rationale: When communicating with clients with Alzheimer's disease, using simple and direct statements is the most appropriate technique. This approach helps to minimize confusion, enhance understanding, and facilitate effective communication with individuals who may have difficulty processing complex information due to their condition.
5. A client with chronic obstructive pulmonary disease is being taught by a nurse about ways to facilitate eating. Which of the following statements indicates a need for further teaching?
- A. I will rest for at least 30 minutes before eating.
- B. I will take my bronchodilators after meals.
- C. I will eat five or six small meals each day.
- D. I will choose foods that are not gas-forming.
Correct answer: B
Rationale: Option B, 'I will take my bronchodilators after meals,' indicates a need for further teaching. Bronchodilators should be taken before meals to help open the airways and make breathing easier before eating. This statement suggests a misunderstanding of the timing for optimal bronchodilator effectiveness. Options A, C, and D are all appropriate strategies for facilitating eating for a client with chronic obstructive pulmonary disease.
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