a nurse is providing care to a client with a spinal cord injury at t6 the client suddenly reports a pounding headache and blurred vision what action s a nurse is providing care to a client with a spinal cord injury at t6 the client suddenly reports a pounding headache and blurred vision what action s
Logo

Nursing Elites

ATI RN

ATI Medical Surgical Proctored Exam

1. A client with a spinal cord injury at T6 suddenly reports a pounding headache and blurred vision. What action should the nurse take first?

Correct answer: B

Rationale: The client's symptoms of a pounding headache and blurred vision are indicative of autonomic dysreflexia, a potentially life-threatening condition in clients with spinal cord injuries at T6 or above. The nurse's priority action should be to check the client's blood pressure as autonomic dysreflexia can lead to severe hypertension. Identifying and addressing this elevated blood pressure promptly is crucial to prevent serious complications such as seizures, stroke, or even death. Once the blood pressure is assessed and managed, further interventions can be implemented to address the underlying cause of autonomic dysreflexia.

2. A nurse is caring for a client diagnose with pancreatitis. The nurse anticipates that the client would not experience an elevation of which of the following enzymes?

Correct answer: B

Rationale: Lactase is produced in the small intestine and aids in splitting neutral fats into glycerol and fatty acids. Lipase, amylase, and trypsin are produced in the pancreas and aid in the digestion of fats, starches, and proteins, respectively.

3. A nurse is caring for a client who has heart failure and is receiving a continuous IV infusion of furosemide. Which of the following findings indicates the nurse should increase the client's infusion rate?

Correct answer: D

Rationale: A weight gain of 1 kg in 24 hours can indicate fluid retention and worsening heart failure, requiring an increase in diuresis. This finding suggests that the current diuretic therapy is not effective enough to manage the fluid overload, necessitating an increase in the infusion rate of furosemide. Choices A, B, and C are not directly related to the need for an increase in diuretic therapy in heart failure patients. Urine output of 20 mL/hr, a heart rate of 90/min, and a sodium level of 138 mEq/L are important parameters to monitor but do not specifically indicate the need to increase the infusion rate of furosemide.

4. One way to determine staffing needs is to classify clients according to nursing care required. Another name for this is a(n) __________.

Correct answer: D

Rationale: The correct answer is D: acuity system. An acuity system involves classifying clients based on the nursing care they require to determine staffing needs accurately. Choice A, self-scheduling, is not related to classifying clients based on care needs. Choice B, supplementing staff system, does not specifically refer to the classification of clients. Choice C, patient classification system (PCS), is close but not as commonly used as 'acuity system' in healthcare settings to determine staffing needs.

5. Charles Darwin's theory of evolution emphasized __________ and __________.

Correct answer: D

Rationale: Charles Darwin's theory of evolution emphasized natural selection and survival of the fittest. Natural selection is the process by which organisms with traits that help them survive and reproduce in their environment are more likely to pass on these traits to their offspring. Survival of the fittest refers to the idea that the organisms best adapted to their environment are more likely to survive and reproduce, leading to the gradual evolution of species over time. Both concepts are central to Darwin's theory of evolution. Choices A, B, and C are incorrect as they do not accurately reflect the key principles highlighted by Darwin in his theory of evolution.

Similar Questions

Which physiologic role does vitamin C play in the body?
A client is taking naproxen following an exacerbation of rheumatoid arthritis. Which of the following statements by the client requires further discussion?
Freud's psychosexual stage that occurs between the ages of 3 and 5 and includes the Oedipal period is the ________ stage.
A nurse is caring for a client who has heart failure and a prescription for furosemide. Which of the following findings should the nurse identify as an indication that the medication is effective?
What should be done to ensure safety during the transfer of a patient with limited mobility?

Access More Features

ATI Basic

  • 50,000 Questions with answers
  • All ATI courses Coverage
    • 30 days access @ $69.99

ATI Basic

  • 50,000 Questions with answers
  • All ATI courses Coverage
    • 90 days access @ $149.99