Adult Medical Surgical ATI

Adult Medical Surgical ATI Related

Review Adult Medical Surgical ATI related questions and content

A client is 1 day postoperative following a lobectomy with a chest tube drainage system in place. Which finding by the nurse indicates a need for intervention?

  • A. Chest tube eyelets not visible
  • B. Continuous bubbling in the suction control chamber
  • C. Presence of tidal fluctuation in the water seal chamber
  • D. Development of subcutaneous emphysema
Correct Answer: D

Rationale: The correct answer is D: Development of subcutaneous emphysema. This finding indicates air leakage, which can lead to potential complications like tension pneumothorax. Subcutaneous emphysema is a serious concern that requires immediate intervention.

A: Chest tube eyelets not visible - This is not a concerning finding as long as the chest tube is properly secured and functioning.
B: Continuous bubbling in the suction control chamber - This can indicate proper functioning of the system.
C: Presence of tidal fluctuation in the water seal chamber - This indicates that the system is working correctly, with the water seal chamber fluctuating with the patient's breathing.

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Expected age-related changes of the pulmonary system include:

  • A. Significant airway obstruction
  • B. Shortness of breath
  • C. Development of emphysema
  • D. A modest,gradual decline in pulmonary function
Correct Answer: D

Rationale: While lung capacity decreases with age, it typically results in a gradual decline rather than significant obstruction or diseases like emphysema unless other factors (e.g., smoking) are present.

During pulmonary hygiene for a client with pneumonia, a nurse positions the client on his left side in Trendelenburg position. From which of the following lung segments should the nurse expect secretions to be mobilized with the client in this position?

  • A. Lateral segment of the left lower lobe
  • B. Lateral segment of the right lower lobe
  • C. Posterior segment of the right middle lobe
  • D. Posterior segment of the right lower lobe
Correct Answer: B

Rationale: The correct answer is B: Lateral segment of the right lower lobe. In Trendelenburg position on the left side, gravity helps drain secretions from the right lung's lateral segments more effectively. The right lower lobe's lateral segment is the most dependent part of the lung in this position, facilitating secretion mobilization. Choices A, C, and D are incorrect because they do not align with the gravitational effect in Trendelenburg position on the left side, making secretion mobilization less efficient in those segments.

What is your evaluation of Mr. Smith’s skin rash and slight fever after taking INH for 3 months?

  • A. Is developing hepatitis
  • B. Has not been taking INH
  • C. Is having a normal response to the medication
  • D. Is demonstrating early signs of drug hypersensitivity
Correct Answer: D

Rationale: The correct answer is D because Mr. Smith's skin rash and slight fever after taking INH for 3 months indicate early signs of drug hypersensitivity. This is supported by the timing of symptoms appearing after prolonged use, which is typical for drug hypersensitivity reactions. Other choices are incorrect: A, developing hepatitis would show different symptoms; B, not taking INH would not explain the symptoms; C, a normal response would not involve rash and fever.

What are the priority nursing diagnoses for a client in shock?

  • A. Increased urine output
  • B. Edema
  • C. Hypertension
  • D. Hypernatremia
Correct Answer: B

Rationale: Edema occurs due to excess fluid accumulation in the interstitial spaces, commonly seen in conditions like heart failure and kidney disease.

Mr. Jones is being discharged today. Which of the following statements by Mr. Jones would indicate that he understands his postoperative regimen?

  • A. I'm taking my nephew to the amusement park next week and we are going to ride the roller-coasters.'
  • B. My brother will be coming over every day to help me with my bath and to shave me.'
  • C. I think I'll watch the baseball games on TV this week rather than driving to the stadium.'
  • D. I guess I'll have to take an early retirement since my job as an accountant requires me to use my eyes a lot.'
Correct Answer: C

Rationale: Avoiding strenuous activities like driving or riding roller coasters demonstrates understanding of activity restrictions necessary during recovery from retinal surgery.

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