Practice Question
During the primary survey of a patient with severe leg trauma, the nurse observes that the patient's left pedal and posterior tibial pulses are absent, and the entire leg is swollen. Which action will the nurse take next?
Answer Choices:
Correct Answer:
Assess further for a cause of the decreased circulation,
Rationale:
🍃 The absence of pedal and posterior tibial pulses with leg swelling suggests vascular compromise, possibly from compartment syndrome or major vascular injury.
🍃 Before initiating fluids or continuing the trauma survey, the nurse must identify the cause of impaired circulation, as limb salvage depends on rapid recognition and intervention.
🍃 Immediate assessment may prompt surgical consultation or compartment pressure measurement.
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This question is from RN ATI Advanced Medsurgical Exam 4 which contains 41 questions.
More Questions from This Exam
A nurse is the triage officer in the emergency department when four clients arrive following a factory explosion. Which of the following clients should the nurse care for first?
Answer Choices:
A. A conscious adult client who reports shortness of breath; has a respiratory rate of 24/min, and capillary refill of
B. A conscious adult client who has a dislocated right shoulder, respiratory rate of 18/min, and capillary refill of
C. An unconscious adult client who has a sucking chest wound, respirations of 38/min, and capillary refill of
D. An unconscious adult client who has no respirations, capillary refill is 2 seconds and paramedics have already tried to reposition airway without results
Gastric lavage and administration of activated charcoal are prescribed for an unconscious patient who has been admitted to the emergency department (ED) after ingesting 30 lorazepam (Ativan) tablets. Which prescribed action should the nurse plan to do first?
Answer Choices:
A. Prepare a 60-mL syringe with saline.
B. Assist with intubation of the patient.
C. Give first dose of activated charcoal.
D. Insert a large-bore orogastric tube.
The following interventions are part of the emergency department (ED) protocol for a patient who has been admitted with multiple bee stings to the hands. Which action should the nurse take first?
Answer Choices:
A. Apply calamine lotion to itching areas.
B. Apply ice packs to both hands.
C. Attempt to remove the patient's stings.
D. Give diphenhydramine (Benadryl) 50 mg PO.
Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN ATI MedSurg
- Answer Choices: 4