ATI MED SURGE CHAPTER 23 EXAM 2020 WITH NGN QUESTIONS, ANSWERS & RATIONALES(UPDATED 2023)

A perioperative nurse is caring for a postoperative patient. The patient has a shallow respiratory pattern and is reluctant to cough or to begin mobilizing. The nurse should address the patient's increased risk for what complication? A) Acute respiratory distress syndrome (ARDS) B) Atelectasis C) Aspiration D) Pulmonary embolism - ANSWER Ans: Atelectasis Feedback: A shallow, monotonous respiratory pattern coupled with immobility places the patient at an increased risk of developing atelectasis. A critical-care nurse is caring for a patient diagnosed with pneumonia as a surgical complication. The nurse's assessment reveals that the patient has an increased work of breathing due to copious tracheobronchial secretions. What should the nurse encourage the patient to do? A) Increase oral fluids unless contraindicated. B) Call the nurse for oral suctioning, as needed. C) Lie in a low Fowler's or supine position. D) Increase activity. - ANSWER Ans: Increase oral fluids unless contraindicated. Feedback: The nurse should encourage hydration because adequate hydration thins and loosens pulmonary secretions. The public health nurse is administering Mantoux tests to children who are being registered for kindergarten in the community. How should the nurse administer this test? A) Administer intradermal injections into the children's inner forearms. B) Administer intramuscular injections into each child's vastus lateralis. C) Administer a subcutaneous injection into each child's umbilical area. D) Administer a subcutaneous injection at a 45-degree angle into each child's deltoid - ANSWER Ans: Administer intradermal injections into the children's inner forearms. Feedback: The purified protein derivative (PPD) is always injected into the intradermal layer of the inner aspect of the forearm. The nurse is caring for a patient who has been in a motor vehicle accident and the care team suspects that the patient has developed pleurisy. Which of the nurse's assessment findings would best corroborate this diagnosis? A) The patient is experiencing painless hemoptysis. B) The patient's arterial blood gases (ABGs) are normal, but he demonstrates increased work of breathing. C) The patient's oxygen saturation level is below 88%, but he denies shortness of breath. D) The patient's pain intensifies when he coughs or takes a deep breath. - ANSWER Ans: The patient's pain intensifies when he coughs or takes a deep breath. Feedback: The key characteristic of pleuritic pain is its relationship to respiratory movement. Taking a deep breath, coughing, or sneezing worsens the pain. The nurse caring for a patient recently diagnosed with lung disease encourages the patient not to smoke. What is the primary rationale behind this nursing action? A) Smoking decreases the amount of mucus production. B) Smoke particles compete for binding sites on hemoglobin. C) Smoking causes atrophy of the alveoli. D) Smoking damages the ciliary cleansing mechanism. - ANSWER Ans: Smoking damages the ciliary cleansing mechanism. Feedback: In addition to irritating the mucous cells of the bronchi and inhibiting the function of alveolar macrophage (scavenger) cells, smoking damages the ciliary cleansing mechanism of the respiratory tract. Smoking also increases the amount of mucus production and distends the alveoli in the lungs. It reduces the oxygen-carrying capacity of hemoglobin, but not by directly competing for binding sites. A patient has been brought to the ED by the paramedics. The patient is suspected of having ARDS. What intervention should the nurse first anticipate? A) Preparing to assist with intubating the patient B) Setting up oxygen at 5 L/minute by nasal cannula C) Performing deep suctioning D) Setting up a nebulizer to administer corticosteroids - ANSWER Ans: Preparing to assist with intubating the patient Feedback: A patient who has ARDS usually requires intubation and mechanical ventilation. The nurse is caring for a patient who is scheduled for a lobectomy for a diagnosis of lung cancer. While assisting with a subclavian vein central line insertion, the nurse notes the client's oxygen saturation rapidly dropping. The patient complains of shortness of breath and becomes tachypneic. The nurse suspects a pneumothorax has developed. Further assessment findings supporting the presence of a pneumothorax include what? A) Diminished or absent breath sounds on the affected side B) Paradoxical chest wall movement with respirations C) Sudden loss of consciousness D) Muffled heart sounds - ANSWER Ans: Diminished or absent breath sounds on the affected side Feedback: In the case of a simple pneumothorax, auscultating the breath sounds will reveal absent or diminished breath sounds on the affected side. Paradoxical chest wall movements occur in flail chest conditions. Muffled or distant heart sounds occur in pericardial tamponade. The nurse is providing discharge teaching for a patient who developed a pulmonary embolism after total knee surgery. The patient has been converted from heparin to sodium warfarin (Coumadin) anticoagulant therapy. What should the nurse teach the client? A) Coumadin will continue to break up the clot over a period of weeks B) Coumadin must be taken concurrent with ASA to achieve anticoagulation. C) Anticoagulant therapy usually lasts between 3 and 6 months. D) He should take a vitamin supplement containing vitamin K - ANSWER Ans: Anticoagulant therapy usually lasts between 3 and 6 months. Feedback: Anticoagulant therapy prevents further clot formation, but cannot be used to dissolve a clot. The therapy continues for approximately 3 to 6 months A new employee asks the occupational health nurse about measures to prevent inhalation exposure of the substances. Which statement by the nurse will decrease the patient's exposure risk to toxic substances? A) "Position a fan blowing on the toxic substances to prevent the substance from becoming stagnant in the air." B) "Wear protective attire and devices when working with a toxic substance." C) "Make sure that you keep your immunizations up to date to prevent respiratory diseases resulting from toxins." D) "Always wear a disposable paper face mask when you are working with inhalable toxins." - ANSWER Ans: "Wear protective attire and devices when working with a toxic substance." Feedback: When working with toxic substances, the employee must wear or use protective devices such as face masks, hoods, or industrial respirators. Immunizations do not confer protection from toxins and a paper mask is normally insufficient protection. An x-ray of a trauma patient reveals rib fractures and the patient is diagnosed with a small flail chest injury. Which intervention should the nurse include in the patient's plan of care? A) Suction the patient's airway secretions. B) Immobilize the ribs with an abdominal binder. C) Prepare the patient for surgery. D) Immediately sedate and intubate the patient. - ANSWER Ans: Suction the patient's airway secretions.