ATI RN
ATI Detailed Answer Key Medical Surgical
1. A client with emphysema is being cared for by a nurse. Which of the following findings should the nurse not expect to assess in this client?
- A. Dyspnea
- B. Bradycardia
- C. Barrel chest
- D. Clubbing of the fingers
Correct answer: Bradycardia
Rationale: Emphysema is a chronic lung condition characterized by shortness of breath (dyspnea), a barrel-shaped chest due to hyperinflation of the lungs (barrel chest), and clubbing of the fingers (enlargement of fingertips). Bradycardia (slow heart rate) is not typically associated with emphysema. In emphysema, the primary focus is on respiratory complications rather than cardiac issues.
2. When measuring the leg circumference of a client with bipedal edema, what position is best to ensure accurate measurements?
- A. Dorsal recumbent
- B. Sitting
- C. Standing
- D. Supine
Correct answer: A
Rationale: When measuring the leg circumference of a client with bipedal edema, the best position to ensure accurate and consistent measurements is the dorsal recumbent position. This position allows the legs to be positioned comfortably, and the individual is lying on their back with legs extended, facilitating accurate measurement of the circumference without the influence of gravity. Sitting, standing, and supine positions may not provide optimal conditions for accurate leg circumference measurements, particularly in clients with bipedal edema where positioning and consistency are crucial. Sitting and standing positions may not allow for consistent leg positioning and could introduce errors due to the effects of gravity on the fluid distribution. The supine position, while similar to dorsal recumbent, may not be as comfortable for the client and could still be influenced by gravity when measuring leg circumference.
3. A client is receiving magnesium sulfate for the management of preeclampsia. Which of the following client assessments should the nurse monitor to prevent complications of therapy?
- A. Bowel sounds
- B. Deep tendon reflexes
- C. Oxygen saturation
- D. Fluid balance
Correct answer: B
Rationale: The correct answer is deep tendon reflexes. Monitoring deep tendon reflexes is crucial to assess for magnesium toxicity during therapy for preeclampsia. Magnesium sulfate can lead to neuromuscular blockade, reflected by decreased or absent deep tendon reflexes. Assessing bowel sounds (choice A) is important for gastrointestinal function but is not directly related to magnesium sulfate therapy. Oxygen saturation (choice C) is vital for respiratory status but is not specifically linked to magnesium sulfate administration. Fluid balance (choice D) is essential but does not directly correlate with monitoring for complications of magnesium sulfate therapy in the context of preeclampsia.
4. A patient develops itching and burning of the vaginal vault while taking an anti-infective to treat strep throat. What fungal agent has most likely caused the burning and itching?
- A. Cryptococcus neoformans
- B. Candida albicans
- C. Aspergillus
- D. Dermatophytes
Correct answer: B
Rationale: The correct answer is B: Candida albicans. Candida albicans is a common fungal agent responsible for causing vaginal yeast infections characterized by itching and burning. It is known to overgrow in the vagina, especially when the normal vaginal flora is disrupted, such as during antibiotic use. Cryptococcus neoformans is more associated with causing meningitis in immunocompromised individuals, not vaginal symptoms. Aspergillus is more commonly associated with lung infections and allergic reactions, not vaginal infections. Dermatophytes typically cause skin infections like ringworm, not vaginal symptoms.
5. Each nonnutritive sweetener can be recommended to patients with phenylketonuria, except one. Which one is the exception?
- A. Cyclamate
- B. Acesulfame-K
- C. Saccharin
- D. Aspartame
Correct answer: D
Rationale: The correct answer is D, Aspartame. Aspartame contains phenylalanine, which is contraindicated for individuals with phenylketonuria (PKU), a genetic disorder that impairs phenylalanine metabolism. Therefore, patients with PKU should avoid aspartame. Choices A, B, and C (Cyclamate, Acesulfame-K, Saccharin) are considered safe for individuals with PKU as they do not contain phenylalanine and can be recommended as alternatives to sugar for these patients.
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