a nurse is suctioning the endotracheal tube of a client who is on a ventilator the clients heart rate increases from 86min to 110min and becomes irreg a nurse is suctioning the endotracheal tube of a client who is on a ventilator the clients heart rate increases from 86min to 110min and becomes irreg
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Nursing Elites

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ATI Detailed Answer Key Medical Surgical

1. While suctioning the endotracheal tube of a client on a ventilator, the nurse notices an increase in the client's heart rate from 86/min to 110/min, with irregularity. What should the nurse do next?

Correct answer: D: Perform pre-oxygenation prior to suctioning.

Rationale: When a client's heart rate increases and becomes irregular during suctioning of an endotracheal tube, it indicates potential hypoxemia. Performing pre-oxygenation before suctioning helps prevent hypoxemia and subsequent dysrhythmias. This intervention ensures that the client has adequate oxygen reserves before the procedure, reducing the risk of complications related to suctioning.

2. A healthcare professional is reviewing admission prescriptions for a group of clients. Which of the following prescriptions should the healthcare professional identify as complete?

Correct answer: D

Rationale: The correct answer is D because it provides the medication (Metoprolol), dosage (5 mg), route of administration (IV), and timing (now), making it a complete prescription. Choices A, B, and C lack either the route of administration or timing, making them incomplete prescriptions. For choice A, it lacks the route of administration, and for choices B and C, they lack the timing of administration.

3. Pertussis vaccination should begin at which age?

Correct answer: B

Rationale: The DTaP vaccine, which includes pertussis, is typically started at 2 months of age as part of the recommended immunization schedule.

4. Dr. Anderson wants to conduct a study to determine the cause-and-effect relationship between domestic violence and anger in children. Dr. Anderson should use a(n) __________ design.

Correct answer: D

Rationale: Dr. Anderson should use an experimental design to determine the cause-and-effect relationship between domestic violence and anger in children. In an experimental design, the researcher manipulates the independent variable (in this case, exposure to domestic violence) to observe its effect on the dependent variable (anger in children). This design allows for the establishment of a cause-and-effect relationship by controlling for other variables that may influence the outcomes. Observational design (Choice B) involves observing subjects in their natural environment without interference, correlational design (Choice C) examines the relationship between variables without manipulating them, and structured design (Choice A) typically refers to a study with predetermined procedures and data collection methods, which may not be suitable for establishing cause-and-effect relationships.

5. A client with schizophrenia starting therapy with clozapine is being discharged. Which symptom should the client report to the provider as the highest priority?

Correct answer: C

Rationale: The correct answer is C: Fever. When a client is taking clozapine, fever can indicate serious conditions such as infection or severe reactions, which need immediate medical attention. Constipation (choice A), blurred vision (choice B), and dry mouth (choice D) are common side effects of clozapine but are not as urgent as fever. Constipation can be managed with dietary changes or medications, blurred vision can improve over time, and dry mouth can be relieved with frequent sips of water.

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