ATI
ATIRNRNMED-SURG
MED-SURG EXIT EXAM AND STUDYGUIDE
EXIT EXAM
NEWEST VERSION 2024 ACTUAL EXAM 150
QUESTIONS
Terms in this set (98)AND CORRECT DETAILED ANSWERS
A nurse is caring for a client B. Assist the client to a supine position.
who is postprocedure C. Administer an opioid medication.
following a lumbar puncture D. Encourage the client to increase fluid intake.
and reports a throbbing
headache when sitting Rationale: (B) The nurse should assist the client to a
upright. Which of the supine position, which can relieve a headache following
following actions should the a lumbar puncture
nurse take? (Select all that (C) The nurse should administer an opioid medication for
apply). a client's report of headache pain. (D) The nurse should
encourage increased fluid intake to maintain a positive
A. Use the Glasgow Coma fluid balance, which can relieve a headache following a
Scale when assessing the lumbar puncture
client.
B. Assist the client to a
supine position.
C. Administer an opioid
medication.
D. Encourage the client to
increase fluid intake.
E. Instruct the client to
perform deep breathing
and coughing exercises.
,A nurse is caring for a client B. Infection
who experienced a
traumatic head injury and Rationale: The nurse should monitor a client who has a
has an intraventricular ventriculostomy for infection, which is a complication.
catheter (ventriculostomy) The nurse should use strict asepsis to avoid this life-
for ICP monitoring. The threatening condition, which can result in meningitis.
nurse should monitor the
client for which of the
following complications
related to the
ventriculostomy?
A. Headache
B. Infection
C. Aphasia
D. Hypertension
A nurse is assessing a client B. E3 + V4 + M4 = 11
for changes in the level of
consciousness using the Rationale: The client's score is calculated correctly,
Glasgow Coma Scale indicating moderate head injury. E3 represents opening
(GCS). The client opens his eyes secondary to voice stimulation, V4 represents the
eyes when spoken to, verbal conversation that is incoherent and disoriented
speaks incoherently, and and M4 represents motor response as general
moves his extremities when withdrawal to pain.
pain is applied. Which of the
following GCS scores
should the nurse
document?
A. E2 + V3 + M5 = 10
B. E3 + V4 + M4 = 11
C. E4 + V5 + M6 = 15
D. E2 + V2 + M4 = 8
,A nurse is developing a A. "I think I might be pregnant."
plan of care for a client who B. "I take warfarin."
is scheduled for cerebral D. "I am allergic to shrimp."
angiography with contrast E. "I ate a light breakfast this morning."
dye. Which of the following
statements by the client Rationale: (A) The nurse should report the client's
should the nurse report to statement of possible pregnancy to the provider
the provider? (Select all because the contrast dye can place the fetus at risk. (B)
that apply). The nurse should report that the client is taking warfarin
to the provider due to the potential for bleeding
A. "I think I might be following angiography (D) The nurse should report a
pregnant." clients report of allergy to shrimp, which is a shellfish, to
B. "I take warfarin." the provider due to a potential allergic reaction to the
C. "I take antihypertensive contrast dye (E) The nurse should report a client's intake
medication." of food to the provider since the client should remain
D. "I am allergic to shrimp." NPO for 4 to 6 hr. prior to the procedure.
E. "I ate a light breakfast this
morning."
, A nurse is providing B. "Try to stay away most of the night prior to the
education to a client who is procedure."
to undergo an
electroencephalogram Rationale: The nurse should teach the client to remain
(EEG) the next day. Which awake most of the night to provide cranial stress and
of the following information increase the possibility of abnormal electrical activity.
should the nurse include in
the teaching?
A. "Do not wash your hair
the morning of the
procedure."
B. "Try to stay away most of
the night prior to the
procedure."
C. "The procedure will take
approximately 15 minutes."
D. "You will need to lie flat
for 4 hours after the
procedure."
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