VATI Med Surg| 100% Correct Questions Rated A+ 1
An emergency room nurse is assessing a client who USE OF ASSCESSORY MUSCLES.
has asthma and difficulty breathing. Which of the
following findings should indicate to the nurse that - A client who has status asthmaticus uses accessory muscles to help
the client is experiencing status asthmaticus? facilitate breathing, which is a manifestation of a severe airflow obstruction.
The situation is life-threatening and the nurse should intervene immediately
with strong systemic bronchodilators, epinephrine, corticosteroids, and
oxygen.
A home health nurse is assisting a client with planning Remove clutter from rooms and hallways
care for a family member who has Alzheimer's
disease. Which of the following instructions should - This allows the client is able to walk without the risk of falling or tripping
the nurse include? over objects. Later in the disease, the client can experience seizures, so
cluttered areas could be a risk to the client
A home health nurse is inspecting a client's residence AN IV PUMP IS PLUGGED INTO AN OUTLET NEAR THE SINK.
for electrical hazards as part of the agency's quality
improvement plan. Which of the following findings - The nurse should plug all electrical appliances into outlets away from wet
should the nurse identify as a safety hazard? areas. Water conducts electricity and places the client at risk for
electrocution.
2/5/2026
,VATI Med Surg| 100% Correct Questions Rated A+ 2
A nurse in a long-term care facility is caring for a PROVIDE FINGER FOOD AT MEALTIME.
client who has dementia. Which of the following
actions should the nurse take? - The nurse should provide the client who has dementia with fingers foods.
Clients who have dementia can have difficulty sitting still and tend to
wander, which makes weight loss and malnutrition a concern. Therefore,
foods that the client can hold while ambulating are ideal.
A nurse in an emergency department is assessing a LOW URINE SPECFIC GRAVITY.
client who is overusing prescribed diuretics and has a -A client who has hyponatremia as a result of diuretic overuse has a low
sodium level of 127 mEq/L. Which of the following urine specific gravity. The increased excretion of water alters the ratio of
laboratory findings should the nurse expect? particulate matter, which affects the specific gravity.
A nurse in an emergency department is caring for a ADMINISTER OXYGEN USING A HIGH-CONCENTRATION MASK.
client who is confused, has a temperature of 40° C
(104° F), a BP of 74/52 mm Hg, and a diagnosis of - The first action the nurse should take when using the airway, breathing, and
exertional heat stroke. Which of the following actions circulation approach to client care is to ensure that the client has a patent
should the nurse take first? airway and administer oxygen using a high-concentration mask to promote
oxygen perfusion to vital organs.
2/5/2026
,VATI Med Surg| 100% Correct Questions Rated A+ 3
A nurse is analyzing the ABG results of a client who is RETENTION OF CARBON DIOXIDE.
in RESPIRATORY ACIDOSIS. Which of the following
mechanisms should the nurse identify as responsible - Retention of carbon dioxide can result from respiratory depression,
for this acid-base imbalance? inadequate chest expansion, airway obstruction, or decreased alveolar
capillary diffusion.
A nurse is assessing a client for fluid volume deficit SURGICAL DRAIN OUTPUT 300 ML DURING AN 8 HOUR SHIFT.
following lumbar spinal surgery. The nurse should
identify which of the following findings as an - A client who had lumbar spinal surgery should not have more than 250 mL
indication the client is at risk for fluid volume deficit? from a drain in the first 24 hr. Therefore, 300 mL in 8 hr can indicate that the
client is at risk for fluid volume deficit.
A nurse is assessing a client's ECG strip and notes an ATRIAL FIBRILLATION.
irregular heart rate of 98/min with NO CLEAR P
WAVES. Which of the following cardiac dysrhythmias - With atrial fibrillation, multiple rapid impulses from many different foci
should the nurse document? cause depolarization of the atria in a rapid, disorganized manner. This causes
a chaotic rhythm on the ECG strip that has no clear P waves, no atrial
contractions, and an irregular rhythm.
2/5/2026
, VATI Med Surg| 100% Correct Questions Rated A+ 4
A nurse is assessing a client's understanding of a CONTACT THE PROVIDER WHO WILL BE PERFORMING THE PROCEDURE.
surgical procedure prior to witnessing their signature
on the informed consent form. The nurse determines - The nurse should advocate for the client by informing the provider if the
that the client does not understand what the client does not understand the procedure. It is the responsibility of the
procedure will involve. Which of the following actions provider to discuss the procedure more fully with the client.
should the nurse take?
A nurse is assessing a client who has a central venous CLOSE THE PINCH CLAMP ON THE CVC.
catheter (CVC) with intravenous (IV) fluids infusing.
The client suddenly develops shortness of breath, and - The greatest risk to this client is air embolism resulting from accidental
the nurse notes that the IV tubing and needleless disconnection of the CVC tubing. Therefore, the priority action is to clamp
connector device are disconnected. Which of the the catheter immediately by closing the pinch clamp to prevent any further
following actions should the nurse take first? air from entering the system. When an air embolism occurs, air enters
through the central vein into the right ventricle and lodges by the pulmonary
valve, decreasing the amount of blood that is able to enter into the ventricle
and the pulmonary arteries.
2/5/2026
An emergency room nurse is assessing a client who USE OF ASSCESSORY MUSCLES.
has asthma and difficulty breathing. Which of the
following findings should indicate to the nurse that - A client who has status asthmaticus uses accessory muscles to help
the client is experiencing status asthmaticus? facilitate breathing, which is a manifestation of a severe airflow obstruction.
The situation is life-threatening and the nurse should intervene immediately
with strong systemic bronchodilators, epinephrine, corticosteroids, and
oxygen.
A home health nurse is assisting a client with planning Remove clutter from rooms and hallways
care for a family member who has Alzheimer's
disease. Which of the following instructions should - This allows the client is able to walk without the risk of falling or tripping
the nurse include? over objects. Later in the disease, the client can experience seizures, so
cluttered areas could be a risk to the client
A home health nurse is inspecting a client's residence AN IV PUMP IS PLUGGED INTO AN OUTLET NEAR THE SINK.
for electrical hazards as part of the agency's quality
improvement plan. Which of the following findings - The nurse should plug all electrical appliances into outlets away from wet
should the nurse identify as a safety hazard? areas. Water conducts electricity and places the client at risk for
electrocution.
2/5/2026
,VATI Med Surg| 100% Correct Questions Rated A+ 2
A nurse in a long-term care facility is caring for a PROVIDE FINGER FOOD AT MEALTIME.
client who has dementia. Which of the following
actions should the nurse take? - The nurse should provide the client who has dementia with fingers foods.
Clients who have dementia can have difficulty sitting still and tend to
wander, which makes weight loss and malnutrition a concern. Therefore,
foods that the client can hold while ambulating are ideal.
A nurse in an emergency department is assessing a LOW URINE SPECFIC GRAVITY.
client who is overusing prescribed diuretics and has a -A client who has hyponatremia as a result of diuretic overuse has a low
sodium level of 127 mEq/L. Which of the following urine specific gravity. The increased excretion of water alters the ratio of
laboratory findings should the nurse expect? particulate matter, which affects the specific gravity.
A nurse in an emergency department is caring for a ADMINISTER OXYGEN USING A HIGH-CONCENTRATION MASK.
client who is confused, has a temperature of 40° C
(104° F), a BP of 74/52 mm Hg, and a diagnosis of - The first action the nurse should take when using the airway, breathing, and
exertional heat stroke. Which of the following actions circulation approach to client care is to ensure that the client has a patent
should the nurse take first? airway and administer oxygen using a high-concentration mask to promote
oxygen perfusion to vital organs.
2/5/2026
,VATI Med Surg| 100% Correct Questions Rated A+ 3
A nurse is analyzing the ABG results of a client who is RETENTION OF CARBON DIOXIDE.
in RESPIRATORY ACIDOSIS. Which of the following
mechanisms should the nurse identify as responsible - Retention of carbon dioxide can result from respiratory depression,
for this acid-base imbalance? inadequate chest expansion, airway obstruction, or decreased alveolar
capillary diffusion.
A nurse is assessing a client for fluid volume deficit SURGICAL DRAIN OUTPUT 300 ML DURING AN 8 HOUR SHIFT.
following lumbar spinal surgery. The nurse should
identify which of the following findings as an - A client who had lumbar spinal surgery should not have more than 250 mL
indication the client is at risk for fluid volume deficit? from a drain in the first 24 hr. Therefore, 300 mL in 8 hr can indicate that the
client is at risk for fluid volume deficit.
A nurse is assessing a client's ECG strip and notes an ATRIAL FIBRILLATION.
irregular heart rate of 98/min with NO CLEAR P
WAVES. Which of the following cardiac dysrhythmias - With atrial fibrillation, multiple rapid impulses from many different foci
should the nurse document? cause depolarization of the atria in a rapid, disorganized manner. This causes
a chaotic rhythm on the ECG strip that has no clear P waves, no atrial
contractions, and an irregular rhythm.
2/5/2026
, VATI Med Surg| 100% Correct Questions Rated A+ 4
A nurse is assessing a client's understanding of a CONTACT THE PROVIDER WHO WILL BE PERFORMING THE PROCEDURE.
surgical procedure prior to witnessing their signature
on the informed consent form. The nurse determines - The nurse should advocate for the client by informing the provider if the
that the client does not understand what the client does not understand the procedure. It is the responsibility of the
procedure will involve. Which of the following actions provider to discuss the procedure more fully with the client.
should the nurse take?
A nurse is assessing a client who has a central venous CLOSE THE PINCH CLAMP ON THE CVC.
catheter (CVC) with intravenous (IV) fluids infusing.
The client suddenly develops shortness of breath, and - The greatest risk to this client is air embolism resulting from accidental
the nurse notes that the IV tubing and needleless disconnection of the CVC tubing. Therefore, the priority action is to clamp
connector device are disconnected. Which of the the catheter immediately by closing the pinch clamp to prevent any further
following actions should the nurse take first? air from entering the system. When an air embolism occurs, air enters
through the central vein into the right ventricle and lodges by the pulmonary
valve, decreasing the amount of blood that is able to enter into the ventricle
and the pulmonary arteries.
2/5/2026
