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ATI RN ADULT MEDICAL SURGICAL PROCTORED EXAM 2019| UPDATED QUESTIONS AND ANSWERS WITH RATIONALE 2023/2024 GRADED A+

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  • December 5, 2023
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  • 2023/2024
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RN VATI ADULT MEDICAL SURGICAL PROCTORED
EXAM 2019| UPDATED QUESTIONS AND ANSWERS WITH
RATIONALE 2023/2024 GRADED A+
Question: 90 of 90
A nurse is caring for a client who has atopic dermatitis and a prescription for triamcinolone ointment. The nurse should
assess the client to monitor for which of the following adverse effects?

● Increased pigmentation
● Topical glucocorticoid therapy can cause the adverse effect of hypopigmentation.
● Localized hair loss
● Long-term glucocorticoid therapy can cause hypertrichosis, or excessive hair growth, especially on the facial area.
● Thinning of the skin
○ Thinning of the skin and delayed healing are adverse effects of topical glucocorticoid preparations. The client
should only apply the ointment to dry patches of the skin because topical steroids can cause atrophy of the dermis
and epidermis, which can result in thinning of the skin.

Question: 89 of 90
A nurse is assessing a client who has left-sided heart failure. Which of the following findings should the nurse identify as a
manifestation of left-sided heart failure?
● Dependent edema
● Jugular distention
● Weight gain
● Frothy sputum
○ The nurse should identify that frothy sputum, dyspnea, and wheezing are manifestations of left-sided heart failure.
Treatment includes fluid restriction and diuretics to decrease preload and reduce pulmonary congestion.
Pink-tinged frothy sputum can be an early indication of pulmonary edema and can be life-threatening. Therefore,
the nurse should notify the provider immediately.

Question: 88 of 90
A nurse is caring for a client who is experiencing anxiety as well as numbness and tingling of the lips and fingers. The client's
ABGs are: pH 7.48, PCO2 30 mm Hg, HCO 3 - 24 mEq/L, PaO2 85 mm Hg. Which of the following acid-base imbalances should
the nurse identify that the client is experiencing?
● Respiratory alkalosis
○ This pH is alkaline (increased) and the PCO2 is decreased, representing alveolar
hyperventilation and resultant respiratory alkalosis.
● Respiratory acidosis
○ This pH is alkaline (increased) and the PCO2 is decreased. A decreased pH and an increased PCO2 indicate
respiratory acidosis.
● Metabolic alkalosis
○ This HCO 3- 24 mEq/L is within the expected range of 21 to 28 mEq/L and the pH is alkaline (increased). An
increased pH and HCO3- indicate metabolic alkalosis.
● Metabolic acidosis
○ This HCO 3- 24 mEq/L is within the expected range of 21 to 28 mEq/L and the pH is alkaline (increased). A
decreased pH and HCO3- indicate metabolic acidosis

Question: 87 of 90
A nurse is assessing a client who has Cushing's syndrome. Which of the following findings should the nurse expect?
● Vitiligo
● Osteoporosis
○ Osteoporosis is a common finding with Cushing's syndrome. Bones become thinner as a result of mineral
loss and nitrogen depletion, and the risk for fractures increases.
● Myxedema
● Heat intolerance

Question: 86 of 90
A nurse is inspecting the skin of a client who has basal cell carcinoma. The nurse should identify which of the following lesion
characteristics on the client's skin?
● A pearly, waxy nodule
○ A client who has basal cell carcinoma has a nodular lesion with well-defined borders and a pearly or waxy
appearance, resulting from overexposure to the sun, especially on the face, head, and neck.
● An irregular border on a variegated-colored lesion
○ A client who has melanoma has a lesion with irregular borders and variegated colors of red, white, and blue,
most often on the upper back or lower legs.
● A firm, nodular, crusty, or ulcerated lesion
○ A client who has squamous cell carcinoma has a firm, nodular, and crusty lesion with an ulcerated center,
resulting from sun exposure, chronic irritation, burns, or irradiation to the skin.
● A weeping vesicle
○ A client who has herpes zoster has weeping, blister-type lesions.

,Question: 85 of 90
A nurse is assessing a client who has hypocalcemia. In which of the following areas should the nurse tap on the client's face to
detect the presence of Chvostek's sign? (You will find hot spots to select in the artwork below. Select only the hot spot that
corresponds to your answer.)




A is correct. The nurse should tap the client's cheek just in front of the ear and below the zygomatic arch. The client who has
hypocalcemia will display a Chvostek's sign, which is a twitching of the facial muscle.

Question: 84 of 90
A nurse in an emergency department is assessing a client who is overusing prescribed diuretics and has a sodium level of 127
mEq/L. Which of the following laboratory findings should the nurse expect?
● Low urine specific gravity
○ A client who has hyponatremia as a result of diuretic overuse has a low urine specific gravity. The
increased excretion of water alters the ratio of particulate matter, which affects the specific gravity. Low
hemoglobin
● Low Hemoglobin
○ A client who is dehydrated as a result of diuretic overuse can have an elevated hemoglobin level because of the
difference in ratio between intravascular fluid and blood cells.
● High lipase
○ A high lipase level is associated with pancreatic dysfunction or renal failure and is not an expected finding with
hyponatremia or dehydration
● High creatine kinase-MB (CK-MB)
○ An elevated CK-MB level indicates a myocardial infarction and is not an expected finding with
hyponatremia.

Question: 83 of 90
A home health nurse is assisting a client with planning care for a family member who has Alzheimer's disease. Which
of the following instructions should the nurse include?
● Remove clutter from rooms and hallways.
○ The nurse should instruct the family member to remove clutter from rooms and hallways so the client is able to
walk without the risk of falling or tripping over objects. Later in the disease, the client can experience seizures,
so cluttered areas could be a risk to the client.
● Place a monthly calendar in the client's room.
○ The nurse should instruct the family member to place a single-date calendar in the client's room. A monthly
calendar can be overwhelming and confusing to a client who has Alzheimer's disease.
● Use confrontation to manage the client's behavior.
○ The nurse should instruct the family member to redirect the client by starting another activity when the client
begins to act out or becomes overstimulated. Redirecting the client might help them gain focus.
● Review the daily schedule with the client every morning.
○ The nurse should instruct the family member to use short, simple sentences when explaining an activity to the
client. The explanation should be done immediately before the activity to aid the client's memory and ability to
follow directions.

Question: 82 of 90
A nurse is caring for a client who has developed acute respiratory distress syndrome (ARDS). Which of the following findings
should the nurse identify as a manifestation of this syndrome?
● An audible pleural friction rub
○ A client who has a pulmonary embolism can have a pleural friction rub along with tachypnea, tachycardia,
dyspnea, and sudden, sharp chest pain. However, a pleural friction rub is not a manifestation of ARDS.
● Tracheal deviation from the midline
○ A client who has a tension pneumothorax can have tracheal deviation with dyspnea, tachycardia, and tachypnea.
On auscultation, breath sounds over the area of the pneumothorax are decreased or absent. However, tracheal
deviation is not a manifestation of ARDS.
● Refractory hypoxemia
○ ARDS is a systemic inflammatory response to trauma, sepsis, burns, pancreatitis, and blood transfusions, when
excess lung fluid dilutes surfactant activity in the lungs. A client who has ARDS has refractory hypoxemia, which
is hypoxemia that does not improve with oxygen therapy. Extensive pulmonary edema evident on a chest x-ray is
a manifestation of ARDS.
● Bloody expectorant when coughing
○ A client who has lung cancer or laryngeal trauma can have hemoptysis. However, bloody expectorant is not a
manifestation of ARDS.

, Question: 81 of 90
An emergency room nurse is assessing a client who has asthma and difficulty breathing. Which of the following findings
should indicate to the nurse that the client is experiencing status asthmaticus?

● Coughing
○ Status asthmaticus causes labored breathing and wheezing. Coughing indicates that the client is exchanging
air and is a manifestation of pneumonia, not status asthmaticus.
● Flat neck veins
○ A client who has status asthmaticus has distended neck veins while trying to facilitate breathing due to
increased pulmonary pressure.
● Use of accessory muscles
○ A client who has status asthmaticus uses accessory muscles to help 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.
● Presence of coarse crackles
○ The presence of coarse crackles indicates air movement through fluid-filled airways and is a manifestation of
pneumonia, not status asthmaticus.

Question: 80 of 90
A nurse is teaching a client who has a new prescription for phenytoin to treat a seizure disorder. Which of the following
adverse effects should the nurse instruct the client to report immediately to the provider?

● Tender, bleeding gums
○ Gingival hyperplasia is an overgrowth of gum tissue that causes the gums to bleed, swell, and become tender.
Gingival hyperplasia is nonurgent adverse effect when a client is taking phenytoin; therefore, there is another
finding that is the priority. The nurse should advise the client to maintain good oral hygiene with a soft toothbrush
and to follow up with an oral health professional.
● Increased facial hair
○ Hirsutism, an increased growth of hair in unexpected places on the client's body, is non urgent
because it is an expected finding for a client who is taking phenytoin.
● Constipation
○ Constipation is non urgent because it is an expected finding for a client who is taking phenytoin.
● Skin rash
○ When using the urgent vs. non urgent approach to client care, the nurse should determine that the priority finding
is a rash, which can have a measles-like appearance and progress to exfoliative dermatitis or Stevens-Johnson
syndrome. The client should report this finding to the provider immediately.

Question: 79 of 90
A nurse is monitoring a client following a lumbar laminectomy. The client has a drain and indwelling urinary catheter.
The nurse should identify which of the following findings as an indication of a complication of the surgery?

● Oral temperature of 37.2° C (99° F)
○ The nurse should expect a slight elevation of the client's temperature postoperatively. However, an
increased temperature elevation or a spike can indicate an infection.
● Clear drainage on the dressings
○ The nurse should identify clear drainage on or around the dressing as an indication of a cerebral spinal leak
and should report this finding to the provider immediately.
● Drain output 75 mL in 4 hr
○ The nurse should expect the client to have no more than 125 mL of drain output in 4 hr. Decreased bowel
sounds in all quadrants of the abdomen
● Decreased bowel sounds in all quadrants of the abdomen
○ The nurse should expect decreased bowel sounds when caring for a client following a laminectomy due to
anesthesia and pain medication. The nurse should continue to monitor the client to assess for a paralytic ileus.

Question: 78 of 90
A nurse is assessing a client who has right-sided heart failure. Which of the following findings should the nurse identify as a
manifestation of right-sided heart failure?

● S3 gallop
○ An S3/S4 summation gallop is an expected finding with left-sided heart failure due to pulmonary
congestion and increased left ventricular pressure that causes a decrease in cardiac output and poor tissue
perfusion.
● Weak peripheral pulses
○ Weak peripheral pulses are an expected finding with left-sided heart failure due to decreased cardiac
output.
● Increased abdominal girth
○ Increased abdominal girth is an expected finding with right-sided heart failure due to systemic congestion and an
enlarged liver and spleen. Systemic congestion can lead to fluid retention and increased pressure in the venous
system, which can manifest with edema in the lower extremities.
● Wheezing
○ Wheezing is an expected finding with left-sided heart failure due to pulmonary congestion and systolic
dysfunction.

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