Practice Question
A nurse is caring for a client who had an evacuation of a subdural hematoma. Which of the following actions should the nurse take first?
Answer Choices:
Correct Answer:
Check the oximeter.
Rationale:
🔸 After brain surgery, the most immediate concern is oxygenation, as brain tissue is highly sensitive to even brief periods of hypoxia.
🔸 Monitoring SpO₂ via pulse oximeter ensures adequate oxygen delivery and alerts the nurse to early signs of respiratory compromise or aspiration risk.
🔸 While monitoring for CSF leaks and increased ICP are important, oxygen delivery takes priority immediately post-op to prevent secondary brain injury.
🔸 Early hypoxia may lead to re-elevation of ICP and poor neurological outcomes if not rapidly addressed.
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This question is from RN ATI Custom Nurs 235 Summer~2023(Final) which contains 65 questions.
More Questions from This Exam
A nurse in an emergency department is preparing to care for a client who is being brought in with multiple system trauma following a motor vehicle crash. Which of the following should the nurse identify as the priority focus of care?
Answer Choices:
A. Preventing musculoskeletal disability
B. Airway protection
C. Stabilizing cardiac arrhythmias
D. Decreasing intracranial pressure
The nurse is caring for a postoperative client who has a chest tube connected to suction and a water seal drainage system. Which of the following indicates to the nurse that the chest tube is functioning properly?
Answer Choices:
A. Equal amount of fluid drainage in each collection chamber
B. Fluctuation of the fluid level within the water seal chamber
C. Continuous bubbling within the water seal chamber
D. Absence of fluid in the drainage tubing
A nurse in the emergency department is caring for a client who has extensive partial and full-thickness bums of the head, neck, and chest. While planning the clients care, the nurse should identify which of the following risks as the priority for assessment and intervention?
Answer Choices:
A. Infection
B. Airway obstruction
C. Paralytic ileus
D. Fluid imbalance
A nurse is monitoring a client who was admited with a severe burn injury and is receiving IV fluid resuscitation therapy. The nurse should identify a decrease in which of the following findings as an indication of adequate fluid replacement?
Answer Choices:
A. Urine output
B. Heart rate
C. Weight
D. Blood pressure
A nurse is caring for a client who has a traumatic head injury and is exhibiting signs of increasing intracranial pressure. Which of the following medications should the nurse plan to administer?
Answer Choices:
A. Dextran 70
B. Hydroxyethyl starch
C. Albumin 25%
D. Mannitol 25%
Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN ATI MedSurg
- Answer Choices: 4
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