Med Surg ATI Capstone
xf xf xf
Axfnursexfonxfaxfmedxfsurgxfunitxfisxfcaringxfforxfaxfgroupxfofxfclients.xfThexfnurs
exfshouldxfnotifyxfthexfrapidxfresponsexfteamxfforxfwhichxfofxfthexffollowingxfcli
ents?
A.xfClientxfwhoxfhasxfanxfulcerationxfofxfthexfrightxfheelxfwhosexfbloodxfglucos
exfisxf300
B.xfClientxfwhoxfreportsxfrightxfcalfxfpainxfandxfshortnessxfofxfbreath
C.xfClientxfwhoxfhasxfbloodxfonxfaxfpressurexfdressingxfinxfthexffemoralxfareaxffo
llowingxfaxfcardiacxfcatheterization
D.xfClientxfwhoxfhasxfdarkxfredxfcolorationxfofxfleftxftoesxfandxfabsentxfpedalxfp
ulsexf-xfcorrectxfanswer✔ ✔ B
Axfnursexfisxfcaringxfforxfaxfclientxfwhoxfhasxfingestedxfaxftoxicxfagent.xfWhichxf
ofxfthexffollowingxfactionsxfshouldxfthexfnursexfplanxftoxftake?xf(Selectxfallxfthat
xfapply)
A.xfInducexfvomiting
B.xfInstillxfactivatedxfcharcoal
C.xfPerformxfaxfgastricxflavagexfwithxfaspiration
D.xfAdministerxfsyrupxfofxfipecac
E.xfInfusexfIVxffluidsxf-xfcorrectxfanswer✔ ✔ B,xfC,xfE
,Axfnursexfinxfthexfemergencyxfdepartmentxfisxfcaringxfforxfaxfclientxfwhoxffellxft
hroughxfthexficexfonxfaxfpondxfandxfisxfunresponsivexfandxfbreathingxfslowly.xf
Whichxfofxfthexffollowingxfactionsxfshouldxfthexfnursexftake?xf(Selectxfallxfthatx
fapply)
A.xfRemovexfwetxfclothing
B.xfMaintainxfnormalxfroomxftemperature
C.xfApplyxfwarmxfblankets
D.xfApplyxfaxfheatxflamp
E.xfInfusexfwarmedxfIVxffluidsxf-xfcorrectxfanswer✔ ✔ A,xfC,xfD,xfE
AxfnursexfinxfthexfEDxfisxfassessingxfaxfclientxfwhoxfisxfunresponsive.xfThexfclie
nt'sxfpartnerxfstates,xf"Hexfwasxfpullingxfweedsxfinxfthexfyardxfandxfslumpedxftoxf
thexfground."xfWhichxfofxfthexffollowingxftechniquesxfshouldxfthexfnursexfusexf
toxfopenxfthexfclient'sxfairway?
A.xfHead-tilt,xfchin-lift
B.xfModifiedxfjawxfthrust
C.xfHyperextensionxfofxfthexfhead
D.xfFlexionxfofxfthexfheadxf-xfcorrectxfanswer✔ ✔ A
, Axfnursexfisxfreviewingxfthexfcommonxfemergencyxfmanagementxfprotocolxffo
rxfclientsxfwhoxfhavexfasystole.xfWhichxfofxfthexffollowingxfactionsxfshouldxfth
exfnursexfplanxftoxftakexfduringxfthisxfcardiacxfemergency?
A.xfPerformxfdefibrillation
B.xfPreparexfforxftranscutaneousxfpacing
C.xfAdministerxfIVxfepinephrine
D.xfElevatexfthexfclient'sxflowerxfextremitiesxf-xfcorrectxfanswer✔ ✔ C
AxfnursexfisxfcaringxfforxfaxfclientxfwhoxfisxfpostproceduralxffollowingxfLPxfand
xfreportsxfthrobbingxfheadachexfwhenxfsittingxfupright.xfWhichxfofxfthexffollow
ingxfactionsxfshouldxfthexfnursexftake?xf(Selectxfallxfthatxfapply)
A.xfUsexfthexfGlasgowxfComaxfScalexfwhenxfassessingxfthexfclient
B.xfAssistxfthexfclientxftoxfaxfsupinexfposition
C.xfAdministerxfanxfopioidxfmedication
D.xfEncouragexfthexfclientxftoxfincreasexffluidxfintake
E.xfInstructxfthexfclientxftoxfperformxfdeepxfbreathingxfexercisesxfandxfcoughin
gxfexercisesxf-xfcorrectxfanswer✔ ✔ B,xfC,xfD
Axfnursexfisxfcaringxfforxfaxfclientxfwhoxfexperiencedxfaxftraumaticxfheadxfinjur
yxfandxfhasxfanxfintraventricularxfcatheterxf(ventriculostomy)xfforxfICPxfmonit
xf xf xf
Axfnursexfonxfaxfmedxfsurgxfunitxfisxfcaringxfforxfaxfgroupxfofxfclients.xfThexfnurs
exfshouldxfnotifyxfthexfrapidxfresponsexfteamxfforxfwhichxfofxfthexffollowingxfcli
ents?
A.xfClientxfwhoxfhasxfanxfulcerationxfofxfthexfrightxfheelxfwhosexfbloodxfglucos
exfisxf300
B.xfClientxfwhoxfreportsxfrightxfcalfxfpainxfandxfshortnessxfofxfbreath
C.xfClientxfwhoxfhasxfbloodxfonxfaxfpressurexfdressingxfinxfthexffemoralxfareaxffo
llowingxfaxfcardiacxfcatheterization
D.xfClientxfwhoxfhasxfdarkxfredxfcolorationxfofxfleftxftoesxfandxfabsentxfpedalxfp
ulsexf-xfcorrectxfanswer✔ ✔ B
Axfnursexfisxfcaringxfforxfaxfclientxfwhoxfhasxfingestedxfaxftoxicxfagent.xfWhichxf
ofxfthexffollowingxfactionsxfshouldxfthexfnursexfplanxftoxftake?xf(Selectxfallxfthat
xfapply)
A.xfInducexfvomiting
B.xfInstillxfactivatedxfcharcoal
C.xfPerformxfaxfgastricxflavagexfwithxfaspiration
D.xfAdministerxfsyrupxfofxfipecac
E.xfInfusexfIVxffluidsxf-xfcorrectxfanswer✔ ✔ B,xfC,xfE
,Axfnursexfinxfthexfemergencyxfdepartmentxfisxfcaringxfforxfaxfclientxfwhoxffellxft
hroughxfthexficexfonxfaxfpondxfandxfisxfunresponsivexfandxfbreathingxfslowly.xf
Whichxfofxfthexffollowingxfactionsxfshouldxfthexfnursexftake?xf(Selectxfallxfthatx
fapply)
A.xfRemovexfwetxfclothing
B.xfMaintainxfnormalxfroomxftemperature
C.xfApplyxfwarmxfblankets
D.xfApplyxfaxfheatxflamp
E.xfInfusexfwarmedxfIVxffluidsxf-xfcorrectxfanswer✔ ✔ A,xfC,xfD,xfE
AxfnursexfinxfthexfEDxfisxfassessingxfaxfclientxfwhoxfisxfunresponsive.xfThexfclie
nt'sxfpartnerxfstates,xf"Hexfwasxfpullingxfweedsxfinxfthexfyardxfandxfslumpedxftoxf
thexfground."xfWhichxfofxfthexffollowingxftechniquesxfshouldxfthexfnursexfusexf
toxfopenxfthexfclient'sxfairway?
A.xfHead-tilt,xfchin-lift
B.xfModifiedxfjawxfthrust
C.xfHyperextensionxfofxfthexfhead
D.xfFlexionxfofxfthexfheadxf-xfcorrectxfanswer✔ ✔ A
, Axfnursexfisxfreviewingxfthexfcommonxfemergencyxfmanagementxfprotocolxffo
rxfclientsxfwhoxfhavexfasystole.xfWhichxfofxfthexffollowingxfactionsxfshouldxfth
exfnursexfplanxftoxftakexfduringxfthisxfcardiacxfemergency?
A.xfPerformxfdefibrillation
B.xfPreparexfforxftranscutaneousxfpacing
C.xfAdministerxfIVxfepinephrine
D.xfElevatexfthexfclient'sxflowerxfextremitiesxf-xfcorrectxfanswer✔ ✔ C
AxfnursexfisxfcaringxfforxfaxfclientxfwhoxfisxfpostproceduralxffollowingxfLPxfand
xfreportsxfthrobbingxfheadachexfwhenxfsittingxfupright.xfWhichxfofxfthexffollow
ingxfactionsxfshouldxfthexfnursexftake?xf(Selectxfallxfthatxfapply)
A.xfUsexfthexfGlasgowxfComaxfScalexfwhenxfassessingxfthexfclient
B.xfAssistxfthexfclientxftoxfaxfsupinexfposition
C.xfAdministerxfanxfopioidxfmedication
D.xfEncouragexfthexfclientxftoxfincreasexffluidxfintake
E.xfInstructxfthexfclientxftoxfperformxfdeepxfbreathingxfexercisesxfandxfcoughin
gxfexercisesxf-xfcorrectxfanswer✔ ✔ B,xfC,xfD
Axfnursexfisxfcaringxfforxfaxfclientxfwhoxfexperiencedxfaxftraumaticxfheadxfinjur
yxfandxfhasxfanxfintraventricularxfcatheterxf(ventriculostomy)xfforxfICPxfmonit
