ATI ADVANCED ADULT MED SURG EXAM GUIDE

ATI ADVANCED ADULT MED SURG EXAM GUIDE

 A nurse is reviewing the health records of clients. Which client is at least risk fordeveloping acute respiratory distress syndrome (ARDS)?- (a) A client who experienced a near-drowning incident in freshwater x (b) A client following coronary artery bypass graft surgery x (c) A client who has a hemoglobin of 10.1 mg/dLpost 1-unit PRBC (d) A client who is experiencing acute pancreatitis and vomitingx  A client presented to the ED after receiving second and third degree burns from a kitchen grease spill. The tops of both thighs, the groin area, and lower abdomen were the areas of injury. About three hours after the injury, the client begins to decompensate and is being prepped for intubation. Regarding the change in the client's status, which explanation by the nurse is correct when educating the client's family? (a)Even aburn as little as 25% of thebody can causea systemic response, requiringemergency management" (b)Theclient is complaining of servepain and will beintubated tosafety given painmedication and seductive (c)The client is experiencing a paralytic ileum and requires intubation to prevent furtherdamage (d)Fluidshift in thebody immediately causeanincreased cardiac output and increasedtissue profusion which can negatively affect the healing process  A nurse is caring fora client who is in the non-progressive (compensatory) stage ofhypervolemic shock. Which finding should the nurse anticipate? *** (a)Multi-organ Dysfunction Syndromeand seizures (b)Increasethirst reflexand moderatevasoconstriction (c)pH 7.5 and potassium level of 3.0 mEq/L –hypokalemia occurs (d)Decrease in MAP by 20 points from baseline  A nurse is reviewing the health records of clients. Which client is at greatest risk fordeveloping Acute Respiratory Distress Syndrome (ARDS) and Multiple Organ Dysfunction Syndrome (MODS)? (a) A client who experienced neurogenic shock (b) A client following anaphylactic shock (c) A client who is experiencing septic shock (d) A client who is experiencing obstructiveshock  When caring fora patient who has septic shock, which assessment finding is mostimportant for the nurse to report to the care provider? (a) BP 92/56 (b) Skin cool and clammy- means progression (c) Apicalpulse118 beats/min (d)Arterial oxygen saturation 91%  Calculate the mean arterial pressure (MAP) in mmHg fora patient with a bloodpressure of 84/46mmHg. (Record answer to the nearest whole number) MAP = SBP + 2 (DBP)/ 3 84+2(46)/3=59  The emergency department nurse is assessing a client who has sustained a bluntinjury to the chest wall. Which finding would indicate the presence of pneumothorax in this client? (a) A low respiratory rate (b) Diminished breathsounds (c) Thepresence of abarrel chest-copd (d) A sucking sound at the siteof injury-open chest  The nurse is assessing the respiratory status of aclient who has suffered afracturedrib.The nurse should expect to note which finding? (a) Slow deep respirations (b)Rapiddeep respiration (c) Paradoxical respirations (d) Pain, especially withinspiration  A client with a chest injury has suffered a flail chest. The nurse assesses the clientfor which most distinctive sign of flail chest? (a) Cyanosis (b)Hypotension (c) Paradoxical chest movement-hall mark (d)Dyspnea,especially onexhalation  A client has been admitted with chest trauma after a motor vehicle crash and has undergone subsequent intubation. The nurse checks the client when the high- pressure alarm on the ventilator sounds and notes that the client has an absence ofbreath sounds in the right upper lobe of the lung. The nurse immediately assesses for other signs of which condition? (a) Right pneumothorax (b) Pulmonary embolism (c) Displaced endotracheal tube (d) Acuterespiratory distress syndrome  A burn patient is brought into the emergency department with the following burns:half of the front torso(9), entire left arm (9), front of left le (9)g. The nurse should record the TBSA burns as. (a)27% TBSA (b)35% TBSA (c)20%TBSA (d)40% TBSA  The client, who is one-day postoperative following chest surgery is having difficultybreathing, has bilateral rales, and is confused and restless. Which intervention should the nurse implement first? (a) Assess theclient pulseoximeter reading(b) Notify the rapid response team (c) Placetheclient intheTrendelenburg position (d) Check theclient’s surgicaldressing