ATI RN
ATI Gastrointestinal System Quizlet
1. A nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis. The client is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment the nurse notes that the abdomen is distended and the bowel sounds are diminished. Which of the following is the most appropriate nursing intervention?
- A. Administer dilaudid
- B. Notify the physician
- C. Call and ask the operating room team to perform the surgery as soon as possible
- D. Reposition the client and apply a heating pad on a warm setting to the client’s abdomen.
Correct answer: B
Rationale: The symptoms suggest possible perforation or peritonitis, which are serious complications requiring immediate medical attention. The nurse should promptly notify the physician.
2. What is a genetic disorder that affects the lungs and digestive system, leading to thick, sticky mucus that can clog the airways?
- A. Cystic fibrosis
- B. COPD
- C. Bronchiectasis
- D. Pulmonary fibrosis
Correct answer: A
Rationale: The correct answer is A, cystic fibrosis. Cystic fibrosis is a genetic disorder that primarily affects the lungs and digestive system. It leads to the production of thick, sticky mucus that can clog the airways, causing respiratory issues. Choice B, COPD (Chronic Obstructive Pulmonary Disease), is a different condition usually caused by smoking or exposure to irritants. Choice C, bronchiectasis, involves the widening and scarring of the airways, not the production of thick mucus. Choice D, pulmonary fibrosis, is a lung disease characterized by scarring of the lung tissue, not excessive mucus production.
3. In caring for an adolescent with severe abdominal pain due to appendicitis, where should the nurse identify as McBurney's point?
- A. Right lower quadrant
- B. Left lower quadrant
- C. Right upper quadrant
- D. Left upper quadrant
Correct answer: A
Rationale: McBurney's point is located in the right lower quadrant of the abdomen, specifically between the umbilicus and the anterior iliac crest. This point is significant in diagnosing appendicitis, as tenderness at McBurney's point is a classic sign of appendicitis and indicates inflammation near the appendix. Therefore, the correct answer is the 'Right lower quadrant.' Choices B, C, and D are incorrect because McBurney's point is not located in the left lower quadrant, right upper quadrant, or left upper quadrant of the abdomen.
4. A nurse is preparing for the hospital admission of a client who is suspected to have active tuberculosis (TB). Which of the following precautions should the nurse plan to implement to safely care for this client?
- A. Staff and visitors should wear gowns, masks, and gloves while in the client's room.
- B. The client should be placed in a private room with a special ventilation system.
- C. The client may be placed in a room with other clients who require droplet isolation precautions.
- D. The protocol for donning and removing personal protective equipment before entering or leaving the room of a client with TB is different than for clients who are in other types of isolation.
Correct answer: The client should be placed in a private room with a special ventilation system.
Rationale: When caring for a client suspected of having active tuberculosis (TB), it is essential to place the client in a private room with a special ventilation system to prevent the spread of TB bacteria to others. Choice A is incorrect because staff and visitors should wear respiratory protection, not just gowns, masks, and gloves. Choice C is incorrect as clients with TB should not be placed in a room with other clients, as they need to be isolated to prevent transmission. Choice D is incorrect because the protocol for donning and removing personal protective equipment for clients with TB is similar to other types of isolation, focusing on proper infection control measures.
5. A nurse manager is planning to teach staff about critical pathways. Which of the following information should the nurse include?
- A. Critical pathways have unlimited timeframes for completion.
- B. Critical pathways are designed to decrease health care costs.
- C. Patients follow the critical pathway if variances occur.
- D. Budgets are used to create the critical pathway.
Correct answer: B
Rationale: The correct answer is B. Critical pathways are structured, multi-disciplinary plans of care designed to decrease health care costs and improve outcomes by standardizing and streamlining processes. Choice A is incorrect because critical pathways have specific timeframes for completion. Choice C is incorrect as patients are expected to follow the critical pathway without deviations to achieve optimal outcomes. Choice D is incorrect because budgets do not create critical pathways; rather, they are based on clinical guidelines and best practices.
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