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ATI n120 med surg exam

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Total Questions : 55

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Question 1:

A client with a history of heart failure presents with progressive shortness of breath over the last several days. Upon assessment, the nurse notes jugular venous distention, crackles in the lung bases auscultated bilaterally, and a bounding pulse. Which of the following interventions would be the nurse's priority?

Answer and Explanation

A
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Question 2:

A nurse is caring for a client who has hypertension and has a potassium level of 6.8 mEq/L. Which of the following actions should the nurse take?

Answer and Explanation

A
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Question 3:

The nurse is assessing a client who recently returned from surgery for a femur fracture. The client begins to complain of pain, numbness, and tingling to the affected extremity. Upon assessment, the extremity is cold to the touch with no pedal pulse and no motor function. Which of the following actions should the nurse take? (Select all that apply)

Answer and Explanation

A
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Question 4:

A nurse is preparing to administer an infusion of intravenous fluids to a client who is at risk for fluid volume overload. Which of the following manifestations would indicate hypervolemia? (Select all that apply)

Answer and Explanation

A
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Question 5:

A nurse is caring for a client who had IV fluids initiated at 0330. The IV fluids are infusing at 120 mL/hr. The nurse should record how many mL of IV fluids on the intake record at 0600?

Answer and Explanation
Correct Answer: "300" mL

Explanation

· Calculate the time elapsed: From 0330 to 0600 is 2.5 hours.

· Calculate the total volume infused: 2.5 hours X 120 mL/hour = 300 mL


A
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Question 6:

A nurse is reviewing the EKG strip of a client who has prolonged vomiting. Which of the following abnormalities on the client's EKG should the nurse interpret as a sign of hypokalemia?

Answer and Explanation

A
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Question 7:

0800

Client brought to ED by ambulance from long-term care facility. According to report from long-term care facility RN. client awoke this morning disoriented to time and place, febrile, and incontinent of foul-smelling urine.

0815:

Provider at bedside, prescriptions received.

A nurse is caring for a client in the emergency department (ED).

Exhibits

Complete the following sentence by using the list of options.

The nurse should first address the client's

followed by the client's

Answer and Explanation

Explanation

  • Fall precautions: The client is disoriented, which significantly increases their risk of falls. Addressing this is the immediate priority for client safety.
  • Antibiotic therapy: The client is febrile and has foul-smelling urine, indicating a likely urinary tract infection (UTI). While important, initiating antibiotic therapy is secondary to ensuring the client's immediate safety from falls.

A
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Question 8:

The nurse is caring for a client who was admitted for an acute exacerbation of Crohn's Disease with severe diarrhea for the last two days. The nurse knows that which of the following is the priority risk for this client?

Answer and Explanation

A
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Question 9:

The nurse is providing education to a patient with chronic pyelonephritis about health promotion activities. Which of the following actions should the nurse include in the teaching?

Answer and Explanation

A
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Question 10:

Which of the following statements regarding hypertonic (3%) sodium chloride is correct?

Answer and Explanation

A
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