ATI RN
test bank for health assessment Questions
Question 1 of 5
What do ABG values of pH 7.38, PO2 78 mmHg, PCO2 36 mmHg, and HCO3 24 mEq/L indicate?
Correct Answer: B
Rationale: Rationale: 1. pH within normal range (7.35-7.45) indicates homeostasis. 2. PO2 (normal 75-100 mmHg) and PCO2 (normal 35-45 mmHg) are slightly deviated but not clinically significant. 3. HCO3 within normal range (22-26 mEq/L) further supports overall balance. Summary: A: Incorrect - HCO3 level is within normal range, ruling out metabolic alkalosis. C: Incorrect - PCO2 is within normal range, ruling out respiratory acidosis. D: Incorrect - PCO2 is slightly low but not significantly, ruling out respiratory alkalosis. Overall, the ABG values indicate the body is in homeostasis.
Question 2 of 5
What should a nurse prioritize for a client with a history of chronic obstructive pulmonary disease (COPD) who is experiencing an exacerbation?
Correct Answer: B
Rationale: Correct Answer: B - Administer oxygen Rationale: 1. Oxygen therapy is crucial in managing COPD exacerbation to improve oxygen saturation levels. 2. Adequate oxygenation is essential to prevent further respiratory distress and potential complications. 3. Oxygen therapy helps alleviate symptoms like shortness of breath and fatigue, improving overall comfort. 4. Monitoring oxygen saturation levels guides the effectiveness of treatment and ensures appropriate oxygen delivery. Summary: - Administering corticosteroids (A) may help reduce inflammation in COPD exacerbation but does not address the immediate need for oxygen. - Monitoring respiratory rate (C) is important but prioritizing oxygen administration is more critical for immediate respiratory support. - Administering diuretics (D) may be indicated in certain cases of COPD exacerbation with fluid retention but is not the priority over oxygen therapy.
Question 3 of 5
What intervention should a nurse recommend for a client with stress incontinence?
Correct Answer: B
Rationale: The correct answer is B: Purchase absorbent undergarments. For stress incontinence, which is caused by weakened pelvic floor muscles, absorbent undergarments can help manage symptoms. Kegel exercises (choice A) strengthen pelvic floor muscles but may not provide immediate relief. Constipation (choice C) can exacerbate incontinence but is not the primary intervention. Surgical treatments (choice D) are not typically recommended as a first-line intervention for stress incontinence.
Question 4 of 5
What type of assessment occurs in emergency situations?
Correct Answer: D
Rationale: In emergency situations, time is crucial. Emergency assessment is the most appropriate as it focuses on quickly identifying and addressing life-threatening issues. It involves a rapid but systematic evaluation of the patient's airway, breathing, circulation, and disability. Head-to-toe assessment (A) and comprehensive assessment (C) are too time-consuming in emergencies, whereas focused assessment (B) may not cover all critical aspects.
Question 5 of 5
What is the first priority for a client who has developed signs of shock?
Correct Answer: A
Rationale: The correct answer is A: Administer IV fluids. In the case of shock, the first priority is to restore circulating volume to improve tissue perfusion. IV fluids help increase blood volume and improve oxygen delivery to vital organs, addressing the underlying cause of shock. Choice B (Administer oxygen) can be important but is not the first priority. Choice C (Place the client in a supine position) may worsen certain types of shock. Choice D (Monitor blood pressure) is important but not the first action needed to address shock. Administering IV fluids promptly can stabilize the client's condition and prevent further deterioration.
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