2019 ATI Medical Surgical Proctored Exam Updated
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ATI RN Medical-Surgical Proctored Exam 2019
A nurse is providing discharge teaching to a client following a modified left radical mastectomy
with breast expander. Which of the following statements by the client indicates an understanding
of the teaching? ----------- Correct Answer ----------- I should expect less than 25 ml of secretions
per day in the drainage devices
A critical care nurse is assessing a client who has a severe head injury. In response to painful
stimuli, the client does not open her eyes, displays decerebrate posturing and makes
incomprehensible sounds. which of the following Glasgow Coma scale scores should the nurse
assign the client? ----------- Correct Answer ----------- 5
A nurse is caring for a client who has a central venous access device and notes the
tubing has become disconnected. The client develops dyspnea and tachycardia. Which
of the following
actions should the nurse take first?
a. Perform an ECG
b. Obtain ABG values
c. Turn the client to his left side
d. Clamp the catheter ---------- Correct Answer ----------- d. Clamp the catheter
A nurse is completing an assessment of an older adult client and notes reddened areas
over the bony prominences, but the client's skin is intact. Which of the following
interventions should the nurse include in the plan of care?
a. Turn and reposition the client every 4 hr
b. Apply an occlusive dressing
c. Support bony prominences with pillows
d. Massage the reddened areas three times a day ---------- Correct Answer ----------- c. Support
bony prominences with pillows
A home health nurse is making an initial visit to a client who has multiple sclerosis.
Which of the following actions is the priority for the nurse to take?
a. Discuss recommendations for eating and swallowing techniques
b. List strategies for family coping when dealing with possible role changes
c. Review the use of adaptive grooming devices to promote client independence
d. Give the client information about the local national multiple sclerosis society ---------- Correct
Answer ----------- a. Discuss recommendations for eating and swallowing techniques
A nurse in the emergency department is assessing a client. Which of the following
actions should the nurse take first? Exhibit
,a. Obtain a sputum sample for culture
b. Administer ondansetron
c. Initiate airborne precautions
d. Prepare the client for a chest x-ray ---------- Correct Answer ----------- c. Initiate airborne
precautions
A nurse is reviewing the medical record of a client to identify risk factors for colorectal
cancer. The nurse should identify which of the following findings as increasing the
client's risk?
a. History of Crohn's disease
b. BMI of 24
c. Diet high in fiber
d. Age 46 years ---------- Correct Answer ----------- a. History of Crohn's disease
A nurse is caring for a client who is scheduled for a mastectomy. The client tells the
nurse, "I'm not sure I want to have a mastectomy." Which of the following statements
should the nurse make?
a. "I can give you a list of other people who had the same procedure"
b. "You will be cancer-free if you have the procedure"
c. "I can give you additional information about the procedure"
d. "You should should get a second opinion regarding the procedure" ---------- Correct Answer --
--------- c. I can give you additional information about the procedure
A nurse is preparing to administer a unit of packed RBCs to a client who is anemic.
Identify the sequence of steps the nurse should follow.
a. Obtain venous access using 19-gauge needle
b. Obtain the unit of packed RBCs from blood bank
c. Verify blood compatibility with another nurse
d. Initiate transfusion of the unit of packed RBCs
e. Remain with the client for the first 15 to 30 min of the infusion ---------- Correct Answer -------
---- a. Obtain venous access using 19-gauge needle
b. Obtain the unit of packed RBCs from blood bank
c. Verify blood compatibility with another nurse
d. Initiate transfusion of the unit of packed RBCs
e. Remain with the client for the first 15 to 30 min of the infusion
A nurse is preparing a teaching plan for a client who has mucositis related to
chemotherapy treatment. Which of the following instructions should the nurse include?
a. "rinse your mouth with hydrogen peroxide"
b. "brush your teeth for 60 seconds twice daily"
c. "wear your dentures only during meals"
d. "floss your teeth following each meals" ---------- Correct Answer ----------- d. Floss your teeth
following each meals
A critical care nurse is assessing a client who has severe head injury. In response to
painful stimuli, the client does not open her eyes, displays decerebrate posturing, and
,makes incomprehensible sounds. Which of the following Glasgow Coma Scale scores
should the nurse assign the client?
a. 5
b. 2
c. 13
d. 10 ---------- Correct Answer ----------- a. 5
A nurse is providing discharge teaching to a client who has heart failure and instructs
him to limit sodium intake to 2 g per day. Which of the following statements by the client
indicates an understanding of the teaching?
a. "I can season my foods with garlic and onion salts"
b. "I can have mayonnaise on my sandwiches"
c. "I can have a frozen fruit juice bar for dessert"
d. "I can drink vegetable juice with a meal" ---------- Correct Answer ----------- c. I can have a
frozen fruit juice bar for dessert
A nurse is preparing to perform ocular irrigation for a client following chemical splash to
the eye. Which of the following actions should the nurse plan to take first?
a. Instill 0.9% sodium chloride solution into the affected eye
b. Administer proparacaine eyedrops into the affected eye
c. Collect information about the irritant that caused the injury ---------- Correct Answer -----------
c. Collect information about the irritant that caused the injury
A nurse is assessing a client following extubation from a ventilator. For which of the
following findings should the nurse intervene immediately?
a. Rhonchi
b. SaO2 92%
c. Sore throat
d. Stridor ---------- Correct Answer ----------- d. Stridor
A nurse is reviewing the laboratory reports of a client who has acute pancreatitis. Which
of the following findings should the nurse expect?
a. Elevated serum calcium
b. Elevated blood glucose
c. Decreased serum amylase
d. Decreased erythrocyte sedimentation rate ---------- Correct Answer ----------- b. Elevated blood
glucose
A nurse is reviewing the medical record of a client who has diabetes insipidus. Which of
the following findings should the nurse expect?
a. Hypothermia
b. Urine specific gravity 1.001 (<1.005)
c. Elevated blood pressure
d. BUN 15 mg/dl ---------- Correct Answer ----------- b. Urine specific gravity 1.001 (<1.005)
A nurse is planning care for a client who has pulmonary embolism. Which of the
, following interventions should the nurse include?
a. Initiate a continuous IV heparin infusion
b. Instruct the client to massage the lower extremities
c. Position the client on the left side
d. Measure vital signs every 4 hour ---------- Correct Answer ----------- a. Initiate a continuous IV
heparin infusion
A nurse is providing discharge teaching to a client who is recovering from a sickle cell
crisis. Which of the following instructions should the nurse include?
a. Avoid extremely hot or cold temperatures
b. Limit fluids to 1.5 L per day
c. Limit alcohol intake to one drink per day
d. Avoid getting a flu vaccination ---------- Correct Answer ----------- a. Avoid extremely hot or
cold temperatures
A nurse in the emergency department is caring for a client who is in hypovolemic shock.
Which of the following actions should the nurse take first?
a. Obtain a blood specimen for type and crossmatch
b. Insert a large-bore IV catheter
c. Administer IV therapy
d. Monitor urine output ---------- Correct Answer ----------- b. Insert a large-bore IV catheter
A nurse is caring for a client who has an arteriovenous graft. Which of the following
findings indicates adequate circulation of the graft?
a. Dilated appearance of the graft
b. Absence of a bruit
c. Normotensive blood pressure
d. Palpable thrill ---------- Correct Answer ----------- d. Palpable thrill
A nurse is assessing a client who has heart failure and is receiving a loop diuretic.
Which of the following findings indicates hypokalemia?
a. Oliguria
b. Hypertension
c. Muscle weakness
d. Positive chvostek's sign (CHEEK) ---------- Correct Answer ----------- c. Muscle weakness
A nurse is caring for a client who has a full-thickness burn injury covering 15% of their
body. Which of the following actions should the nurse take?
a. Weigh the client once per week
b. Provide the client with a protein intake of 1g/kg/day
c. Maintain a daily count of the client's calorie intake
d. Place the client on a low-carb diet ---------- Correct Answer ----------- c. Maintain a daily count
of the client's calorie intake
A nurse is providing discharge teaching to a client who has an ileostomy. Which of the
following client statements indicates an understanding of the teaching?
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