ATI RN
ATI Medical Surgical Proctored Exam 2023
1. While assessing a client with a tracheostomy, a nurse notes that the tracheostomy tube is pulsing with the heartbeat during a pulse check. No other abnormal findings are noted. What action should the nurse take?
- A. Notify the operating room of a potential emergency case.
- B. No action is required at this time; this pulsation can be a normal finding in some clients.
- C. Remove the tracheostomy tube and ventilate the client using a bag-valve-mask.
- D. Stay with the client and ask someone else to contact the provider immediately.
Correct answer: D
Rationale: The pulsation of the tracheostomy tube with the heartbeat may indicate a tracheoinnominate artery fistula, which can lead to life-threatening hemorrhage if the artery is breached. In this scenario, as there is no active bleeding yet, the nurse should remain with the client and have another person notify the provider immediately. If the client starts to hemorrhage, the nurse should remove the tracheostomy tube and apply pressure at the bleeding site, preparing the client for urgent surgical intervention.
2. A client is prescribed albuterol (Proventil) via a metered-dose inhaler. Which action should the nurse take to ensure effective use of this medication?
- A. Instruct the client to inhale quickly while administering the medication.
- B. Have the client hold their breath for 10 seconds after inhaling the medication.
- C. Tell the client to exhale immediately after inhaling the medication.
- D. Encourage the client to use the inhaler as needed only when experiencing symptoms.
Correct answer: B
Rationale: To ensure effective use of albuterol via a metered-dose inhaler, the nurse should have the client hold their breath for 10 seconds after inhaling the medication. This action allows the medication to reach deeper into the airways. Inhaling slowly and deeply, not quickly, is recommended for optimal drug delivery. Exhaling immediately after inhaling the medication would expel it before it can take effect. It's essential for the client to follow the prescribed regimen of medication usage, not just using the inhaler when symptoms are present.
3. A client is wearing a Venturi mask to receive oxygen, and the dinner tray has arrived. What action by the nurse is best?
- A. Assess the client's oxygen saturation and, if normal, turn off the oxygen.
- B. Determine if the client can switch to a nasal cannula during the meal.
- C. Have the client lift the mask off the face when taking bites of food.
- D. Turn off the oxygen while the client eats the meal and then restart it.
Correct answer: B
Rationale: In this scenario, the nurse should determine if the client can safely switch to a nasal cannula during meals. It is crucial to ensure that the provider has approved this change. Oxygen is considered a medication and should be delivered continuously. Turning off the oxygen or lifting the mask while eating can lead to a decrease in the FiO2 delivered, potentially compromising the client's oxygenation status. Therefore, the best course of action is to ascertain if transitioning to a nasal cannula is appropriate for the client during the meal.
4. A client with chronic obstructive pulmonary disease (COPD) is being taught by a nurse. What nutrition information should the nurse include in the teaching?
- A. Avoid drinking fluids just before and during meals.
- B. Rest before meals if experiencing dyspnea.
- C. Consume about six small meals a day.
- D. Consume high-fiber foods to promote gastric emptying.
Correct answer: D
Rationale: While some of the other options may be helpful, the most appropriate advice for a client with COPD is to consume high-fiber foods to promote gastric emptying. Avoiding fluids just before and during meals can help prevent bloating, resting before meals can assist with dyspnea, and having several small meals a day can help reduce bloating. However, fibrous foods can lead to gas production, causing abdominal bloating and potentially worsening shortness of breath. Increasing calorie and protein intake is essential to prevent malnourishment. It is also important to avoid excessive carbohydrate intake, as it can increase carbon dioxide production and the risk of acidosis in COPD patients.
5. A healthcare provider assesses a client with pneumonia. Which clinical manifestation should the provider expect to find?
- A. Fremitus
- B. Hyperresonance
- C. Dullness on percussion
- D. Decreased tactile fremitus
Correct answer: C
Rationale: Pneumonia often leads to the consolidation of lung tissue, resulting in dullness on percussion. This occurs due to the presence of fluid or inflammatory material in the alveoli. Fremitus and decreased tactile fremitus are more indicative of conditions like pleural effusion or pneumothorax, where there is an increase in the density of the pleural space or air in the pleural cavity. Hyperresonance, on the other hand, is typically associated with conditions causing air trapping, such as emphysema, where there is increased air in the alveoli.
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