Question 1

A nurse is caring for a client who has confusion and lethargy. The client was unresponsive at home, with an empty bottle of aspirin laying next to her bed. Vital signs are BP 104/72, HR 116 and regular, and RR 42 with deep breaths. Which of the following ABG results should the nurse expect? A. pH 7.68, PaCO2 38, HCO3 28 B. pH 7.48, PaCO2 28, HCO3 23 C. pH 7.16 PaCO2 38, HCO3 18 D. pH 7.58, PaCO2 38, HCO3 29

Accepted Answer

C. pH 7.16 PaCO2 38, HCO3 18

Question 2

A nurse is caring for a client who was in a motor vehicle crash. The client reports chest pain and difficulty breathing. A chest x-ray indicates that the client has a pneumothorax. Which of the following ABG results should the nurse expect? A. pH 7.06 PaCO2 52 HCO3 24 B. pH 7.42 PaCO2 38 HCO3 23 C. pH 7.20 PaCO2 39 HCO3 18 D. pH 7.58 PaCO2 38 HCO3 29

Accepted Answer

A. pH 7.06 PaCO2 52 HCO3 24

Question 3

A nurse is checking ABG results for a client who has vomited repeatedly during the past 24 hr. Which of the following acid-base imbalances should the nurse expect? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

Accepted Answer

D. Metabolic alkalosis

Question 4

A nurse is caring for a client who has metabolic acidosis. Which of the following components of the client's medical history should the nurse identify as a risk factor for this acid-base imbalance? A. Diabetic ketoacidosis B. Sleep apnea C. Asthma D. Pulmonary edema

Accepted Answer

A. Diabetic ketoacidosis

Question 5

A nurse is collecting data from a client who has pancreatitis. The client's ABGs indicate metabolic acidosis. Which of the following findings should the nurse expect? (Select all that apply) ``` A. Tachycardia B. Hypertension C. Bounding pulses D. Insomnia E. Dysrhythmias F. Tachypnea ```

Accepted Answer

A. Tachycardia E. Dysrhythmias F. Tachypnea

Question 6

A nurse is orienting a newly licensed nurse who is caring for a client who is receiving mechanical ventilation and is on pressure support ventilation (PSV) mode. Which of the following statements by the newly licensed nurse indicates an understanding of PSV? A. It keeps the alveoli open and prevents atelectasis. B. It allows preset pressure delivered during spontaneous ventilation. C. It guarantees minimal minute ventilator. D. It delivers a present ventilatory rate and tidal volume to the client.

Accepted Answer

B. It allows preset pressure delivered during spontaneous ventilation.

Question 7

A nurse is caring for a client who is experiencing respiratory distress. Which of the following are early clinical manifestations of hypoxemia? (Select all that apply) ``` A. Confusion B. Pale skin C. Bradycardia D. Hypotension E. Elevated blood pressure ```

Accepted Answer

B, E Pale skin and elevated blood pressure are early clinical manifestations of hypoxemia

Question 8

A nurse is orienting a newly licensed nurse on performing routine assessment of a client who is receiving mechanical ventilation via a endotracheal tube. Which of the following should the nurse include in the teaching? A. Apply a vest restraint if self-extubation is attempted B. Monitor ventilator settings every 8 hours C. Document tube placement in centimeters at the angle of jaw D. Assess breath sounds every 1 to 2 hours

Accepted Answer

D. The nurse should assess the breath sounds of a client on mechanical ventilation every 1-2 hours

Question 9

A nurse is caring for a client who has dyspnea and is to receive oxygen continuously. Which of the following oxygen devices should the nurse use to deliver a precise amount of oxygen to the client? A. Nonrebreather mask B. Venturi mask C. Nasal cannula D. Simple face mask

Accepted Answer

B. A venturi mask incorporates an adapter that allows a precise amount of oxygen to be delivered to the client

Question 10

A nurse is planning care for a client who is receiving mechanical ventilation. Which mode of ventilation increases the effort of the client's respiratory muscles? (Select all that apply) ``` A. Assist-control B. Synchronized intermittent mandatory ventilaiton C. Continuous positive airway pressure D. Pressure support ventilation E. Independent lung ventilation ```

Accepted Answer

B, C, D

Question 11

A nurse is caring for several clients. Which of the following clients are at risk for having a pulmonary embolism? (Select all that apply) A. A client who has a BMI of 30 B. A female client who has postmenopausal C. A client who has a fractured femur D. A client who is a marathon runner E. A client who has chronic atrial fibrillation

Accepted Answer

A, C, E Obesity, a long bone fracture, and turbulent blood flow in the heart increase the risk for a blood clot

Question 12

A nurse is reviewing prescriptions for a client who has acute dyspnea and diaphoresis. The client states that she is anxious because she feels that she cannot get enough air. Vital signs are: HR 117/min, RR 38/min, temp 38.4 (101.2), BP 100/54. Which of the following actions is the priority action at this time? A. Notify the provider B. Administer heparin via IV infusion C. Administer oxygen therapy D. Obtain a spiral CT scan

Accepted Answer

C. Meeting the oxygenation needs first is the priority action according to ABCs

Question 13

A nurse is caring for a client who has a new prescription for heparin therapy. Which of the following statements by the client should indicate an immediate concern for the nurse? A. I am allergic to morphine B. I take antacids several times a day C. I had a blood clot in my leg several years ago D. It hurts to take a deep breath

Accepted Answer

B. The greatest risk to this client is the possibility of bleeding from a peptic ulcer. Further assessment should be completed and the nurse should notify the provider of the finding

Question 14

A nurse is assessing a client who has a pulmonary embolism. Which of the clinical manifestations should the nurse expect to find? (Select all that apply) ``` A. Bradypnea B. Pleural friction rub C. Hypertension D. Petechiae E. Tachycardia ```

Accepted Answer

B, D, E

Question 15

A nurse is caring for a client who is to receive fibrinolytic thrombolytic therapy. Which of the following should the nurse recognize as a contraindication to the therapy? A. Hip arthroplasty 2 weeks ago B. Elevated sedimentation rate C. Incident of exercise-induced asthma 1 week ago D. Elevated platelet count

Accepted Answer

A. Clients who have undergone a major surgical procedure within the last 3 weeks should not receive thrombolytic therapy because of the risk of hemorrhage from the surgical site.

Question 16

A nurse in the emergency department is assessing a client who was in a motor vehicle crash. Findings include absent breath sounds in the left lower lobe with dyspnea, blood pressure 118/68 mm Hg, hear rate 124/min, respiratory rate 38/min, temperature 38.6C (101/4F), and SaO2 92% on room air. Which of the following actions should the nurse take first? A. Obtain a chest x-ray B. Prepare for chest tube insertion. C. Administer oxygen via a high-flow mask D. Initiate IV access

Accepted Answer

C. Administer oxygen via a high-flow mask

Question 17

A nurse is orienting a newly licensed nurse on the purpose of administering vecuronium to a client who has acute respiratory distress syndrome. Which of the following statements by the newly licensed nurse indicates understanding of the teaching? A. This medication is given to treat infection. B. This medication is given to facilitate ventilation. C. This medication is given to decrease inflammation. D. This medication is given to reduce anxiety.

Accepted Answer

B. This medication is given to facilitate ventilation.

Question 18

A nurse is reviewing the health records of five clients. Which of the following clients are at risk for developing acute respiratory distress syndrome (ARDS)? (Select all that apply) A. A client who experienced a near-drowning incident B. A client following coronary artery bypass graft surgery C. A client who has a hemoglobin of 15.1 mg/dL D. A client who has dysphagia E. A client who experienced a drug overdose

Accepted Answer

A. A client who experienced a near-drowning incident B. A client following coronary artery bypass graft surgery D. A client who has dysphagia E. A client who experienced a drug overdose

Question 19

A nurse is planning care for a client who has severe acute respiratory distress syndrome (SARS). Which of the following should be included in the plan of care for this client? (Select all that apply) ``` A. Administer antibiotics B. Providing supplemental oxygen C. Administer antiviral medictions D. Administration of bronchodilators E. Maintaining ventilatory support ```

Accepted Answer

B. Providing supplemental oxygen D. Administration of bronchodilators E. Maintaining ventilatory support

Question 20

A nurse is caring for a client who is receiving vecuronium for acute respiratory distress syndrome (ARDS). Which of the following medications should the nurse anticipate administering with this medication? (Select all that apply) ``` A. Fentanyl B. Furosemide C. Midazolam D. Famotidine E. Dexamethasone ```

Accepted Answer

A. Fentanyl C. Midazolam

Question 21

A nurse is orienting a newly licensed nurse on the care of a client who is receiving hemodynamic monitoring. Which of the following statements by the newly licensed nurse indicates the teaching was effective? A. Air should be instilled into the monitoring system prior to the procedure. B. The client should be positioned on the left side during the procedure. C. The transducer should be level with the second intercostal space after the line is placed. D. A chest x-ray is needed to verify placement after the procedure.

Accepted Answer

D. A chest x-ray is needed to verify placement after the procedure.

Question 22

A nurse is assessing a client who is undergoing hemodynamic monitoring. The client has a CVP of 7 mm Hg and a PAWP of 17 mmHg. Which of the following findings should the nurse expect? (Select all that apply) ``` A. Poor skin turgor B. Bilateral crackles C. JVD D. Dry mucous membranes E. Hepatomegaly ```

Accepted Answer

B. Bilateral crackles C. JVD E. Hepatomegaly

Exam 3 - ATI Questions Flashcards

Plus Nurse Sarah questions from her website

Brainscape's Knowledge GenomeTM

Exam 3 - ATI Questions Flashcards

Plus Nurse Sarah questions from her website

Brainscape's Knowledge Genome^TM