Proctored ATI MEDSURG Exam Questions With Correct Marking Scheme
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Course
ATI MEDSURG
Institution
ATI MEDSURG
Proctored ATI MEDSURG Exam Questions With Correct Marking Scheme
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Proctored ATI MEDSURG Exam Questions With Correct Marking Scheme
A home health nurse is reinforcing teaching with a client about preventing complications of peripheral vascular dis...
Proctored ATI MEDSURG 2023-2024
Exam Questions With Correct Marking
Scheme
A home health nurse is reinforcing teaching with a client about preventing complications
of peripheral vascular disease. Which of the following statements
indicates that the client is adhering to the nurse's instructions?
1) I use hot water bottles to keep my feet warm at night
2) I don't cross my legs anymore.
3) I apply rubbing alcohol to my feet everyday to prevent infection
4) I will wear clean, knee-high wool socks every day to help improve my circulation. - 2)
I don't cross my legs anymore.
- Clients who have peripheral vascular disease should not cross their legs because it
can impede circulation.
- Clients who have peripheral vascular disease have decreased sensation of the
affected extremities. Therefore, they are unable to detect the temperature of the water
bottle, which increases the risk for burns.
- Rubbing alcohol has a drying effect on skin and can increase cracking, allowing an
entry point for infection. The client should apply lotions that do not contain alcohol.
- Wool socks can result in perspiration, which puts the client at risk for developing a
fungal infection. The client should use light-weight socks to promote arterial blood flow.
/.A nurse enters the room of a client whose transfusion of packed RBC's was initiated
15 minutes ago by a RN. The client reports dyspnea and urticaria. Which
of the following actions should the nurse preform first?
1) Stop the infusion
2) Administer antihistamine
3) Count the client's respiratory rate
4) Ask the client if chest pain is present - 1) Stop the infusion
- Evidence-based practice indicates the nurse should stop the infusion of the blood
product as soon as manifestations occur because they can indicate a transfusion
reaction.
,- The nurse should administer antihistamines when allergic transfusion manifestations
are present. However, evidence-based practice indicates that the nurse should take a
different action first.
- The nurse should take the client's vital signs, which includes counting the client's
respiratory rate. However, evidence-based practice indicates that the nurse should take
a different action first.
- The nurse should inquire about the presence of chest pain and other manifestations to
determine the severity of the reaction. However, evidence-based practice indicates that
the nurse should take a different action first.
/.A nurse in a long term care facility is collecting data from a client who reports fullness
in the rectum and abdominal cramping. Which of the following findings
should indicate to the nurse that the client might have a fecal impaction?
1) Rebound tenderness
2) Halitosis
3) Hemorrhoids
4) Small liquid stools - 4) Small liquid stools
- Small liquid stools can be the result of fecal material being expelled around an
impaction.
- Rebound tenderness is an indication of appendicitis. A client who has a fecal
impaction can experience abdominal cramping and distention.
- Halitosis, or bad breath, is associated with the ingestion of certain foods and
medications, and it can also be an indication of infection.
- Hemorrhoids indicate that the client is straining when defecating. However, the
presence of hemorrhoids does not indicate fecal impaction.
/.A nurse in an oncology clinic is reinforcing teaching about Mohs surgery with a client
who has skin cancer. Which of the following information should the nurse
include in the teaching?
1) Mohs surgery is a palliative treatment for metastatic skin cancer.
2) Mohs surgery is the preferred treatment for melanoma skin cancer.
3) Mohs surgery uses liquid nitrogen to destroy the cancerous tissue.
4) Mohs surgery is a horizontal shaving of thin layers of the tumor. - 4) Mohs surgery is
a horizontal shaving of thin layers of the tumor.
- Mohs surgery is performed to treat basal and squamous cell carcinoma. The
procedure, which involves a horizontal shaving of thin layers of a tumor, has a high
treatment rate.
,- Radiation, rather than Mohs surgery, can be used as a palliative treatment for
metastatic skin cancer.
- Mohs surgery is the preferred treatment for basal and squamous cell carcinoma. The
preferred treatment for melanoma is a wide, full thickness surgical excision.
- Cryosurgery, rather than Mohs surgery, uses liquid nitrogen to destroy cancerous
tissue.
/.A nurse is assisting a client who reports difficulty falling asleep. Which of the following
activities should the nurse recommend to promote sleep?
1) Listen to soft music before sleeping.
2) Take a brisk walk before sleeping
3) Get out of bed if unable to fall asleep within 60 minutes.
4) Drink adequate amounts of fluid before sleeping - 1) Listen to soft music before
sleeping.
- Listening to soft music can help the client to relax and reduces environmental
stressors.
- The client should avoid stimulating activities, such as exercise, before bedtime.
- The client should get out of bed after 30 min if unable to fall asleep.
- The client should reduce fluids 2 to 4 hr before sleep. Drinking fluids before bedtime
can cause the client to wake up during the night to use the bathroom.
/.A nurse is assisting in the care of a client who has manifestations of sepsis. Which
of the following provider prescriptions should the nurse implement first?
1) Collect a sputum specimen
2) Administer ceftriaxone
3) Initiate oxygen at 4L/min
via nasal cannula
4) Obtain blood cultures - 3) Initiate oxygen at 4L/min
via nasal cannula
- When using the airway, breathing, circulation approach to client care, the first action
the nurse should take is to initiate oxygen. Clients who have manifestations of sepsis
are often hypoxic, tachypneic, or have a PaCO2 level less than 32 mm Hg. The nurse
should provide supplemental oxygen to keep the client's oxygen saturation levels at
95% or greater, which will maximize the ability of the hemoglobin to support the oxygen
needs of the body.
, - The nurse should collect a sputum culture to identify the organism causing the client's
infection. Antimicrobial sensitivities are obtained from the sputum culture to guide the
provider in prescribing antibiotics. However, there is another prescription the nurse
should implement first.
- The nurse should administer antibiotics to treat the infection. A broad spectrum
antibiotic, such as ceftriaxone, is administered when sepsis is suspected because it
treats both gram-positive and -negative bacteria. After the results of the blood and
sputum cultures are obtained, the provider will often change to a more specific
antibiotic. However, there is another prescription the nurse should implement first.
- The nurse should obtain blood cultures to identify the organism causing the client's
infection. Antimicrobial sensitivities obtained from the blood cultures will guide the
provider in prescribing treatment. However, there is another prescription the nurse
should implement first.
/.A nurse is assisting in the plan of care regarding bowel retraining for a client whom has
a cervical spinal cord injury. Which of the following interventions should the
nurse plan to implement first?
1) Administer a suppository to the client 30 minutes prior to defecation time.
2) Determine the client's daily elimination habits.
3) Offer the client 4 oz of warm prune juice to promote elimination.
4) Provide dietary bulk to the client to ease the passage of stool. - (correct Answer)- 2)
Determine the client's daily elimination habits.
- The first action the nurse should take using the nursing process is to collect data
on the client's daily bowel elimination habits to establish a routine defecation time.
- The nurse should administer a suppository to the client 30 min prior to defecation
time to stimulate bowel elimination. However, there is another action the nurse
should take first.
- The nurse should offer the client warm prune juice to stimulate peristalsis to
promote elimination. However, there is another action the nurse should take first.
- The nurse should provide dietary bulk to the client to ease the passage of stool
and stimulate bowel elimination. However, there is another action the nurse should
take first.
/.A nurse is assisting the charge nurse with developing an in-service about caring for
clients who have internal sealed radiation implants. Which of the following information
should the nurse include?
1) Pick up a radiation implant with a double-gloved hand if it becomes dislodged
2) Limit time spent in the client's room to 2 hours during an 8 hour shift
3) Restrict the time pregnant women are allowed in the clients room to 15 minutes
4) Dispose of radiation implants in a lead container - 4) Dispose of radiation implants in
a lead container
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