ATI RN
ATI Capstone Medical Surgical Assessment 1 Quizlet
1. What are the manifestations of increased intracranial pressure (IICP)?
- A. Restlessness, confusion, irritability
- B. Severe nausea and vomiting
- C. Elevated blood pressure and bradycardia
- D. Decreased heart rate and altered pupil response
Correct answer: A
Rationale: The correct manifestations of increased intracranial pressure (IICP) include restlessness, confusion, and irritability. These symptoms are a result of the brain being under pressure inside the skull. Severe nausea and vomiting (Choice B) are more commonly associated with increased intracranial pressure in children. Elevated blood pressure and bradycardia (Choice C) are not typical manifestations of increased intracranial pressure; instead, hypertension and bradycardia may be seen in Cushing's reflex, which is a late sign of increased IICP. Decreased heart rate and altered pupil response (Choice D) are also not primary manifestations of increased intracranial pressure, although altered pupil response, like a non-reactive or dilated pupil, can be seen in some cases.
2. A patient with a history of venous thromboembolism is prescribed hormone replacement therapy (HRT). What should the nurse emphasize about the risks associated with this therapy?
- A. HRT is associated with an increased risk of venous thromboembolism, so patients should be educated about the signs and symptoms of blood clots.
- B. HRT may improve mood and energy levels, but it also increases the risk of osteoporosis.
- C. HRT can decrease the risk of fractures, but it also increases the risk of developing diabetes.
- D. HRT may increase the risk of breast cancer, so regular mammograms are essential.
Correct answer: A
Rationale: HRT is associated with an increased risk of venous thromboembolism, so patients should be educated about the signs and symptoms of blood clots and advised to seek immediate medical attention if they occur.
3. What is the most common cause of bronchiolitis in infants?
- A. Adenovirus
- B. Influenza virus
- C. Respiratory syncytial virus
- D. Parainfluenza virus
Correct answer: C
Rationale: The correct answer is C, Respiratory syncytial virus (RSV). RSV is the leading cause of bronchiolitis, a common respiratory condition in infants that results in inflammation of the small airways in the lung. It is highly contagious and can cause severe respiratory distress in young children, particularly those under 2 years old. Choice A, Adenovirus, is not the most common cause of bronchiolitis in infants. Choice B, Influenza virus, may cause respiratory infections but is not the primary cause of bronchiolitis. Choice D, Parainfluenza virus, can cause croup and other upper respiratory infections but is not the main cause of bronchiolitis in infants.
4. A nurse is teaching a parent of a child who has asthma. Which of the following instructions should the nurse include?
- A. Use a peak flow meter daily.
- B. Administer the medication with meals.
- C. Provide a low-carbohydrate diet.
- D. Limit exposure to cold air.
Correct answer: A
Rationale: The nurse should instruct the parent to use a peak flow meter daily to monitor the child�s respiratory status and detect early signs of an asthma attack.
5. Which electrolyte imbalance should be closely monitored in patients on diuretics?
- A. Hypokalemia
- B. Hyponatremia
- C. Hyperkalemia
- D. Hypercalcemia
Correct answer: A
Rationale: The correct answer is A: Hypokalemia. Patients on diuretics are at risk of developing hypokalemia due to increased potassium excretion by the kidneys. Hypokalemia can lead to serious consequences such as cardiac arrhythmias. Hyponatremia (choice B) is an imbalance of sodium levels and is not typically associated with diuretic use. Hyperkalemia (choice C) is the opposite condition where potassium levels are elevated and is less common in patients on diuretics. Hypercalcemia (choice D) is an excess of calcium in the blood and is not directly related to diuretic use. Therefore, monitoring for hypokalemia is crucial in patients taking diuretics.
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