ATI RN
ATI Capstone Medical Surgical Assessment 1 Quizlet
1. What are the signs of compartment syndrome?
- A. Unrelieved pain, pallor, pulselessness
- B. Muscle weakness, hyporeflexia
- C. Pins-and-needles sensation, swelling
- D. Severe swelling and tightness in the affected extremity
Correct answer: A
Rationale: The correct signs of compartment syndrome include unrelieved pain, pallor, and pulselessness due to increased pressure within a muscle compartment. Choice B, muscle weakness, and hyporeflexia are not typical signs of compartment syndrome. Choice C, pins-and-needles sensation and swelling, are not specific signs of compartment syndrome. Choice D, severe swelling and tightness in the affected extremity, could be seen in compartment syndrome but are not the primary signs.
2. What is the priority action for a patient experiencing chest pain from acute coronary syndrome?
- A. Administer sublingual nitroglycerin
- B. Administer aspirin
- C. Obtain IV access
- D. Check cardiac enzymes
Correct answer: A
Rationale: The correct answer is to administer sublingual nitroglycerin. This medication helps to dilate the blood vessels, reduce the workload on the heart, and improve blood flow to the heart muscle, providing immediate relief for chest pain in acute coronary syndrome. Administering aspirin is also crucial in the early management of acute coronary syndrome to prevent further clot formation. However, in terms of immediate symptom relief, nitroglycerin takes precedence over aspirin. Obtaining IV access is important for administering medications and fluids but is not the priority over providing immediate relief for chest pain. Checking cardiac enzymes is essential for diagnosing acute coronary syndrome but is not the immediate priority when a patient is experiencing chest pain.
3. What is the first medication to give for wheezing due to an allergic reaction?
- A. Albuterol via nebulizer
- B. Cromolyn 20 mg via nebulizer
- C. Methylprednisolone 100 mg IV
- D. Aminophylline 500 mg IV
Correct answer: A
Rationale: Albuterol is the first-line medication for treating wheezing due to an allergic reaction. Albuterol is a short-acting beta-agonist that helps relieve bronchospasm quickly. Cromolyn is more commonly used for the prevention of asthma symptoms rather than for acute treatment. Methylprednisolone and aminophylline are not the first-line medications for acute wheezing due to an allergic reaction.
4. A nurse is providing discharge teaching to a client following a heart transplant. Which of the following information should the nurse include in the teaching?
- A. Immunosuppressant medications need to be taken for up to 1 year
- B. Shortness of breath might be an indication of transplant rejection
- C. The surgical site will heal in 3 to 4 weeks after surgery
- D. Begin 45 minutes of moderate aerobic exercise per day following discharge
Correct answer: B
Rationale: The correct answer is B. Shortness of breath is an important sign of transplant rejection. Other manifestations of rejection include fatigue, edema, bradycardia, and hypotension. Choices A, C, and D are incorrect because: A) Immunosuppressant medications are typically required for life, not just up to 1 year. C) The surgical site healing time can vary and may take longer than 3 to 4 weeks. D) Starting a specific exercise regimen should be individualized and guided by healthcare providers; a general recommendation like 45 minutes of exercise per day may not be suitable for all heart transplant recipients.
5. 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.
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