ATI RN
ATI Capstone Medical Surgical Assessment 2 Quizlet
1. What is the purpose of an escharotomy?
- A. To relieve pressure and improve circulation in burn injuries
- B. To reduce pain in the affected area
- C. To remove necrotic tissue from a wound
- D. To prevent infection from spreading
Correct answer: A
Rationale: An escharotomy is performed to relieve pressure and improve circulation in areas affected by deep burns. This procedure helps prevent complications such as compartment syndrome by releasing the constricting eschar. Choice B is incorrect because while pain relief may be a secondary outcome of the procedure, the primary purpose is to address pressure and circulation issues. Choice C is incorrect as an escharotomy specifically focuses on releasing pressure, not removing necrotic tissue. Choice D is incorrect as the primary goal of an escharotomy is not to prevent infection but rather to address the immediate issues related to deep burn injuries.
2. What is the primary concern in a patient with a low CD4 T-cell count in HIV?
- A. Increased risk of infection
- B. Increased risk of bleeding
- C. Decreased immunity leading to opportunistic infections
- D. Increased risk of cardiac complications
Correct answer: A
Rationale: The correct answer is A: Increased risk of infection. In HIV patients with a low CD4 T-cell count, the primary concern is the increased susceptibility to infections due to compromised immunity. This compromised immune system can lead to various infections, making infection control crucial. Choice B, increased risk of bleeding, is not directly associated with a low CD4 count in HIV. Option C, decreased immunity leading to opportunistic infections, conveys a similar concern as the correct answer but lacks specificity. Choice D, increased risk of cardiac complications, is not typically the primary concern in HIV patients with a low CD4 count, as infections and opportunistic diseases pose more immediate threats to health.
3. A nurse is teaching a client about using a continuous positive airway pressure (CPAP) device to treat obstructive sleep apnea. Which of the following information should the nurse include in the teaching?
- A. It delivers a preset amount of inspiratory pressure throughout the breathing cycle
- B. It has a continuous adjustment feature that changes the airway pressure throughout the cycle
- C. It delivers a preset amount of airway pressure throughout the breathing cycle
- D. It delivers positive pressure at the end of each breath
Correct answer: C
Rationale: The correct answer is C because a CPAP device delivers a preset amount of positive airway pressure continuously throughout all inspiration and expiration cycles. Choice A is incorrect because CPAP does not deliver inspiratory pressure at the beginning of each breath; it provides continuous positive pressure. Choice B is incorrect because CPAP typically delivers a constant pressure rather than having a feature that changes pressure throughout the cycle. Choice D is incorrect as CPAP does not deliver positive pressure specifically at the end of each breath; it maintains a consistent pressure throughout the breathing cycle.
4. What is the first nursing action for a patient admitted with chest pain from acute coronary syndrome?
- A. Administer sublingual nitroglycerin
- B. Check the patient's urine output
- C. Administer IV fluids
- D. Obtain cardiac enzymes
Correct answer: A
Rationale: The correct answer is to administer sublingual nitroglycerin. This is the priority action for a patient admitted with chest pain from acute coronary syndrome. Nitroglycerin helps dilate blood vessels, improve blood flow to the heart, and relieve chest pain. Checking the patient's urine output (Choice B) is not the priority in this situation. Administering IV fluids (Choice C) may not be necessary unless indicated by the patient's condition. Obtaining cardiac enzymes (Choice D) is important but is not the initial action needed to address the patient's acute symptoms.
5. What teaching should be provided to a patient following cataract surgery?
- A. Avoid NSAIDs
- B. Wear dark glasses outdoors
- C. Creamy white drainage is normal
- D. Avoid alcohol
Correct answer: A
Rationale: The correct teaching to provide to a patient following cataract surgery is to avoid NSAIDs. NSAIDs should be avoided post-cataract surgery to reduce the risk of bleeding. Choice B, wearing dark glasses outdoors, is important to protect the eyes from bright light but is not directly related to medication use. Choice C, stating that creamy white drainage is normal, is incorrect as drainage should be monitored for excessive redness, swelling, or pain. Choice D, avoiding alcohol, is not a direct post-cataract surgery teaching point related to medication use.
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