ATI Detailed Answer Key Medical Surgical

ATI Detailed Answer Key Medical Surgical Related

Review ATI Detailed Answer Key Medical Surgical related questions and content

When assessing a client with a pneumothorax and a chest tube, which finding should the nurse notify the provider about?

  • A. Movement of the trachea toward the unaffected side
  • B. Bubbling of the water in the water seal chamber with exhalation
  • C. Crepitus in the area above and surrounding the insertion site
  • D. Eyelets not visible
Correct Answer: A

Rationale: Step 1: Movement of the trachea toward the unaffected side indicates tension pneumothorax, a life-threatening condition requiring immediate intervention.
Step 2: This finding can lead to compromised breathing and hemodynamic instability if not addressed promptly.
Step 3: B: Bubbling in the water seal chamber with exhalation is expected in a properly functioning chest tube system.
Step 4: C: Crepitus at the insertion site is common due to air entering subcutaneous tissue during tube placement and is not an urgent concern.
Step 5: D: Eyelets not visible can indicate dislodgement but is not as critical as tracheal deviation in this scenario.

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A client developed fat embolism syndrome (FES) following a fracture. Which of the following laboratory findings should the nurse expect?

  • A. Decreased serum calcium level
  • B. Decreased level of serum lipids
  • C. Decreased erythrocyte sedimentation rate (ESR)
  • D. Increased platelet count
Correct Answer: A

Rationale: The correct answer is A: Decreased serum calcium level. In fat embolism syndrome (FES), fat globules enter the bloodstream and can cause hypocalcemia due to the formation of calcium soaps. This can lead to symptoms such as confusion and tetany. The other choices are incorrect because in FES, there is no direct impact on serum lipids or ESR. Platelet count may be normal or decreased due to the consumption of platelets in the process.

A client has periodic outbreaks of cold sores long after the initial infection of herpes simplex virus. Why does this occur?

  • A. The client has low resistance.
  • B. The client has not received proper treatment.
  • C. The viruses are dormant in the client.
  • D. The viruses are immune to the therapy.
Correct Answer: C

Rationale: The correct answer is C because the herpes simplex virus can become dormant in nerve cells and reactivate periodically, leading to recurrent outbreaks.

Cognitive changes include memory problems, confusion, and disorientation. These changes:

  • A. Occur in 75% of patients over age 65
  • B. Are not a normal part of aging
  • C. Are due to enhanced cerebral blood flow
  • D. Cause senile plaques and neurofibrillary tangles
Correct Answer: B

Rationale: Cognitive decline is not a normal part of aging; it may indicate underlying conditions such as dementia or Alzheimer's disease. Normal aging involves mild forgetfulness but not significant impairment.

For a patient with osteogenic sarcoma, you would be particularly vigilant for elevations in which laboratory value?

  • A. Sodium.
  • B. Calcium.
  • C. Potassium.
  • D. Hematocrit.
Correct Answer: B

Rationale: Elevated calcium levels are commonly associated with osteogenic sarcoma due to bone destruction and release of calcium into the bloodstream.

How can a nurse foster effective coping skills?

  • A. Deep breathing exercises
  • B. Avoid social interactions
  • C. Ignore stressors
  • D. Increase workload
Correct Answer: B

Rationale: The correct answer is B because it is the most appropriate response based on physiological and medical principles.

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