ATI MEDICAL SURGICAL FINAL EXAM LATEST| 2023/2024 VERSION
QUESTIONS AND ANSWERS
1. The nurse is assessing the respiratory status of a client who has suffered a fractured rib.
Which observation if made by the nurse would not be related to the fractured rib?
a) *Slow deep respirations
b) Splinting or guarding the chest
c) Pain especially with inspiration
d) Bruising over the fractured area.
2. A patient is admitted to the respiratory unit with flail chest. The nurse should know that
flail chest is?
a) Pneumothorax
b) Tension pneumothorax
c) Blood rapidly collects in pericardial sac.
d) *Fracture of two or more adjacent ribs in two or more places
3. An hour after a left thoracotomy, a patient reports incisional pain at a level 7 (based on 0
to 10 scale) and has decreased left-sided breath sounds. The pleural drainage system has
100 mL of bloody drainage and a large air leak. Which action should the nurse take?
a) Clamp the chest tube in two places.
b) *Administer the prescribed morphine.
c) Milk the chest tube to remove any clots.
d) Assist the patient with incentive spirometry.
4. The nurse monitors a patient in the emergency department after chest tube placement for
a hemopneumothorax. Which assessment finding is of most concern?
a) A large air leak in the water-seal chamber
b) Report of pain with each deep inspiration
c) *400 mL of blood in the collection chamber
d) Subcutaneous emphysema at the insertion site
5. A patient has a chest wall contusion as a result of being struck in the chest with a
baseball bat. Which initial assessment finding is of most concern to the emergency
department nurse?
a) Report of chest wall pain
b) Heart rate of 110 beats/min
c) *Paradoxical chest movement
d) Large, bruised area on the chest
6. The emergency department nurse notes tachycardia and absent breath sounds over the
right thorax of a patient who has just arrived after an automobile accident. For which
intervention will the nurse prepare the patient?
a) Emergency pericardiocentesis
b) Stabilization of the chest wall
c) Bronchodilator administration
d) *Chest tube insertion connected to suction.
,7. The nurse receives change-of-shift report on the following four patients. Which patient
should the nurse assess first?
a) A 77-yr-old patient with tuberculosis (TB) who has four medications due.
b) *A 46-yr-old patient on bed rest who reports sudden onset of shortness of breath.
c) A 35-yr-old patient with pneumonia who has a temperature of 100.2° F (37.8° C)
d) A 23-yr-old patient with cystic fibrosis who has pulmonary function testing scheduled.
8. The nurse provides discharge teaching for a patient who has two fractured ribs from an
automobile accident. Which patient statement indicates that teaching has been effective?
a) I am going to buy a rib binder to wear during the day.
b) I can take shallow breaths to prevent my chest from hurting.
c) I should plan on taking the pain pills only at bedtime so I can sleep.
d) *I will use the incentive spirometer every hour or two during the day.
9. The nurse is caring for a patient who has a right-sided chest tube after a right lower
lobectomy. Which nursing action can the nurse delegate to the unlicensed assistive personnel
(UAP)?
a) *Document the amount of drainage every 8 hours. Correct
b) Obtain samples of drainage for culture from the system.
c) Assess patient pain level associated with the chest tube.
d) Check the water-seal chamber for the correct fluid level.
10. A patient is admitted to the emergency department with an open stab wound to the left
chest. What action should the nurse take?
a) Keep the head of the patient’s bed positioned flat.
b) Cover the wound tightly with an occlusive dressing.
c) Position the patient so that the left chest is dependent.
d) *Tape a nonporous dressing on three sides over the wound.
11. Which primary manifestation results from the decreased filling of the cardiac ventricles
associated with diastolic failure?
a) Decreased afterload
b) Decreased left ventricular ejection fraction
c) Decreased left ventricular end-diastolic pressure
d) *Decreased stroke volume and cardiac output (CO)
12. Which patient at a wellness clinic has the highest risk for developing primary
hypertension?
a) A 65-year-old retired white patient with a BMI of 15
b) A 45-year-old patient who has chronic pain caused by cancer
c) *A 65-year-old black patient who has a body mass index (BMI) of 35
d) A 45-year-old factory worker who smokes one pack of cigarettes per day
13. The nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which nursing
action should the nurse include on the care plan?
, a) Maintain the patient on bed rest.
b) Auscultate lung sounds every 4 hours.
c) Monitor for Trousseau’s and Chvostek’s signs.
d) *Encourage fluid intake up to 4000 mL every day.
14. A 73-yr-old patient has been hospitalized for 4 days with acute kidney injury (AKI)
caused by dehydration. Which information will be most important for the nurse to report to
the nurse-in-charge?
a) The creatinine level is 2.9 mg/dL.
b) *Urine output over an 8-hour period is 2400 mL.
c) The blood urea nitrogen (BUN) level is 55 mg/dL.
d) The glomerular filtration rate is less than 30 mL/min/1.73 m
15. The nurse is preparing to administer sodium polystyrene sulfonate rectally to a patient
with an irregular pulse and weakness of the lower extremities. What laboratory finding does
the nurse determine is the reason for this treatment?
a) Hypokalemia
b) Hypocalcemia
c) *Hyperkalemia
d) Hypercalcemia
16. Order: 1020 ml of Ensure Nutritional feed over 8 hours? What is the rate per hour that
you will set on the pump?
a) 70 ml/hr
b) 80 ml/hr
c) 127 ml/hr
d) *128 ml/hr
e) Another amount
17. The provider prescribes 5,000 units of Heparin subcutaneous B.I.D. Available is a
multidose vial that is labeled: Heparin 10,000 units/5 mL. How many mL of heparin should
the nurse administer with each dose?
a) 0.8 mL
b) 1.8 mL
c) 2.0 mL
d) *2.5 mL
e) Another amount
18. A nurse is caring for a patient who has ingested a large amount of fluid and has a sodium
level of 131 mEq/L. Which of the following actions should the nurse take?
a) Obtain a 12-lead ECG.
b) *Restrict oral and intravenous fluids
c) Suggest that the patient use a salt substitute.
d) Obtain a blood sample for a serum sodium level.
QUESTIONS AND ANSWERS
1. The nurse is assessing the respiratory status of a client who has suffered a fractured rib.
Which observation if made by the nurse would not be related to the fractured rib?
a) *Slow deep respirations
b) Splinting or guarding the chest
c) Pain especially with inspiration
d) Bruising over the fractured area.
2. A patient is admitted to the respiratory unit with flail chest. The nurse should know that
flail chest is?
a) Pneumothorax
b) Tension pneumothorax
c) Blood rapidly collects in pericardial sac.
d) *Fracture of two or more adjacent ribs in two or more places
3. An hour after a left thoracotomy, a patient reports incisional pain at a level 7 (based on 0
to 10 scale) and has decreased left-sided breath sounds. The pleural drainage system has
100 mL of bloody drainage and a large air leak. Which action should the nurse take?
a) Clamp the chest tube in two places.
b) *Administer the prescribed morphine.
c) Milk the chest tube to remove any clots.
d) Assist the patient with incentive spirometry.
4. The nurse monitors a patient in the emergency department after chest tube placement for
a hemopneumothorax. Which assessment finding is of most concern?
a) A large air leak in the water-seal chamber
b) Report of pain with each deep inspiration
c) *400 mL of blood in the collection chamber
d) Subcutaneous emphysema at the insertion site
5. A patient has a chest wall contusion as a result of being struck in the chest with a
baseball bat. Which initial assessment finding is of most concern to the emergency
department nurse?
a) Report of chest wall pain
b) Heart rate of 110 beats/min
c) *Paradoxical chest movement
d) Large, bruised area on the chest
6. The emergency department nurse notes tachycardia and absent breath sounds over the
right thorax of a patient who has just arrived after an automobile accident. For which
intervention will the nurse prepare the patient?
a) Emergency pericardiocentesis
b) Stabilization of the chest wall
c) Bronchodilator administration
d) *Chest tube insertion connected to suction.
,7. The nurse receives change-of-shift report on the following four patients. Which patient
should the nurse assess first?
a) A 77-yr-old patient with tuberculosis (TB) who has four medications due.
b) *A 46-yr-old patient on bed rest who reports sudden onset of shortness of breath.
c) A 35-yr-old patient with pneumonia who has a temperature of 100.2° F (37.8° C)
d) A 23-yr-old patient with cystic fibrosis who has pulmonary function testing scheduled.
8. The nurse provides discharge teaching for a patient who has two fractured ribs from an
automobile accident. Which patient statement indicates that teaching has been effective?
a) I am going to buy a rib binder to wear during the day.
b) I can take shallow breaths to prevent my chest from hurting.
c) I should plan on taking the pain pills only at bedtime so I can sleep.
d) *I will use the incentive spirometer every hour or two during the day.
9. The nurse is caring for a patient who has a right-sided chest tube after a right lower
lobectomy. Which nursing action can the nurse delegate to the unlicensed assistive personnel
(UAP)?
a) *Document the amount of drainage every 8 hours. Correct
b) Obtain samples of drainage for culture from the system.
c) Assess patient pain level associated with the chest tube.
d) Check the water-seal chamber for the correct fluid level.
10. A patient is admitted to the emergency department with an open stab wound to the left
chest. What action should the nurse take?
a) Keep the head of the patient’s bed positioned flat.
b) Cover the wound tightly with an occlusive dressing.
c) Position the patient so that the left chest is dependent.
d) *Tape a nonporous dressing on three sides over the wound.
11. Which primary manifestation results from the decreased filling of the cardiac ventricles
associated with diastolic failure?
a) Decreased afterload
b) Decreased left ventricular ejection fraction
c) Decreased left ventricular end-diastolic pressure
d) *Decreased stroke volume and cardiac output (CO)
12. Which patient at a wellness clinic has the highest risk for developing primary
hypertension?
a) A 65-year-old retired white patient with a BMI of 15
b) A 45-year-old patient who has chronic pain caused by cancer
c) *A 65-year-old black patient who has a body mass index (BMI) of 35
d) A 45-year-old factory worker who smokes one pack of cigarettes per day
13. The nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which nursing
action should the nurse include on the care plan?
, a) Maintain the patient on bed rest.
b) Auscultate lung sounds every 4 hours.
c) Monitor for Trousseau’s and Chvostek’s signs.
d) *Encourage fluid intake up to 4000 mL every day.
14. A 73-yr-old patient has been hospitalized for 4 days with acute kidney injury (AKI)
caused by dehydration. Which information will be most important for the nurse to report to
the nurse-in-charge?
a) The creatinine level is 2.9 mg/dL.
b) *Urine output over an 8-hour period is 2400 mL.
c) The blood urea nitrogen (BUN) level is 55 mg/dL.
d) The glomerular filtration rate is less than 30 mL/min/1.73 m
15. The nurse is preparing to administer sodium polystyrene sulfonate rectally to a patient
with an irregular pulse and weakness of the lower extremities. What laboratory finding does
the nurse determine is the reason for this treatment?
a) Hypokalemia
b) Hypocalcemia
c) *Hyperkalemia
d) Hypercalcemia
16. Order: 1020 ml of Ensure Nutritional feed over 8 hours? What is the rate per hour that
you will set on the pump?
a) 70 ml/hr
b) 80 ml/hr
c) 127 ml/hr
d) *128 ml/hr
e) Another amount
17. The provider prescribes 5,000 units of Heparin subcutaneous B.I.D. Available is a
multidose vial that is labeled: Heparin 10,000 units/5 mL. How many mL of heparin should
the nurse administer with each dose?
a) 0.8 mL
b) 1.8 mL
c) 2.0 mL
d) *2.5 mL
e) Another amount
18. A nurse is caring for a patient who has ingested a large amount of fluid and has a sodium
level of 131 mEq/L. Which of the following actions should the nurse take?
a) Obtain a 12-lead ECG.
b) *Restrict oral and intravenous fluids
c) Suggest that the patient use a salt substitute.
d) Obtain a blood sample for a serum sodium level.
