ATI RN
ATI Capstone Adult Medical Surgical Assessment 2
1. What should be taught to a patient following cataract surgery?
- A. Avoid NSAIDs
- B. Wear dark glasses when outdoors
- C. Report green or yellow drainage immediately
- D. Itching is normal unless accompanied by pain and nausea
Correct answer: A
Rationale: The correct answer is to avoid NSAIDs after cataract surgery to reduce the risk of bleeding. Choice B, wearing dark glasses when outdoors, is generally recommended after cataract surgery to protect the eyes from bright sunlight, but it is not the most critical instruction. Choice C, reporting green or yellow drainage immediately, is important to monitor for signs of infection, but it is not specific to cataract surgery. Choice D, itching is normal unless accompanied by pain and nausea, is not the most crucial advice post-cataract surgery. Therefore, the key instruction is to avoid NSAIDs to minimize bleeding risk.
2. A nurse is preparing to discharge a client who has a new diagnosis of chronic kidney disease (CKD). Which of the following referrals should the nurse plan to initiate?
- A. Respiratory therapy
- B. Hospice care
- C. Occupational therapy
- D. Dietary services
Correct answer: D
Rationale: The correct answer is D: Dietary services. Referring the client to dietary services is essential for managing nutrition, including monitoring sodium, potassium, and protein intake, which are crucial aspects of managing chronic kidney disease (CKD). Respiratory therapy (choice A) focuses on managing respiratory conditions, which are not directly related to CKD. Hospice care (choice B) is not appropriate for a new diagnosis of CKD as it is designed for end-of-life care. Occupational therapy (choice C) is beneficial for improving activities of daily living but is not the priority referral for a new CKD diagnosis.
3. What is an escharotomy and why is it performed?
- A. A surgical incision made to improve circulation in burn injuries
- B. A procedure to remove dead tissue from a wound
- C. A procedure to remove excess fluid from the lungs
- D. A procedure to relieve pain from burns
Correct answer: A
Rationale: An escharotomy is a surgical procedure involving an incision through the eschar (dead tissue) to relieve pressure in burn injuries. It is performed to improve circulation to the affected area, prevent further damage, and restore blood flow. Choice B is incorrect because an escharotomy is not primarily focused on removing dead tissue but rather on relieving pressure. Choice C is incorrect as it describes a procedure related to pulmonary issues, not burn injuries. Choice D is incorrect because while pain relief may be a result of an escharotomy, it is not the primary purpose of the procedure.
4. What is the priority action for a patient experiencing chest pain from acute coronary syndrome?
- A. Administer sublingual nitroglycerin
- B. Obtain IV access
- C. Check the patient's cardiac enzymes
- D. Administer aspirin
Correct answer: A
Rationale: The correct answer is to administer sublingual nitroglycerin. Nitroglycerin helps relieve chest pain by dilating blood vessels and improving blood flow to the heart, which is crucial in managing acute coronary syndrome. While obtaining IV access and checking cardiac enzymes are important steps in the assessment and management of acute coronary syndrome, administering nitroglycerin takes precedence to alleviate symptoms and reduce cardiac tissue damage. Administering aspirin is also essential in the treatment of acute coronary syndrome, but it is not the immediate priority in this scenario.
5. A nurse is reviewing the medical record of a client who has unstable angina. Which of the following findings should the nurse report to the provider?
- A. Breath sounds
- B. Temperature
- C. Blood pressure
- D. Creatine kinase
Correct answer: A
Rationale: The correct answer is A: Breath sounds. When caring for a client with unstable angina, changes in breath sounds could indicate left ventricular failure and pulmonary edema due to decreased cardiac output and reduced cardiac perfusion. Reporting any abnormalities in breath sounds promptly to the provider is crucial to prevent further complications. Choices B, C, and D are not directly related to the immediate management of unstable angina. Temperature, blood pressure, and creatine kinase levels are important parameters to monitor but are not the priority in this situation.
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