ATI RN MED SURG Exam Questions and
ANSWERS
1. A nurse in a burn treatment center is caring for a client who is admitted with
severe burns to both lower extremities and is pending an escharotomy. The client’s
spouse asks the nurse what the procedure entails. Which of the following nursing
statements is appropriate?
a. “large incisions will be made in the eschar to improve circulation”
b. “ I can call the doctor back here if you want me to”
c. “a piece of skin will be removed and grafted over the burned area”
d. “dead tissue will be surgically removed”
2. A nurse is monitoring the fluid replacement of a client who has sustained burns.
Which of the following fluids is used in the first 24 hours following a burn injury?
a. 5% dextrose in water
b. 5% dextrose in normal saline
c. normal saline
d. lactated ringers
3. A nurse is caring for a client who has full-thickness burns all over 75% of his
body. Which of the following methods is appropriate to accurately monitor the
cardiovascular system?
a. auscultate cuff blood pressure
b. palpate pulse pressure
c. obtain a central venous pressure
d. monitor the pulmonary artery pressure
4. A nurse is assessing the depth and extent of a client who has severe burns to the
face, neck, and upper extremities. Which of the following factors is the first priority
when assessing the severity of the burn?
a. Age of the client
b. Associated medical history
c. Location of the burn
d. Cause of the burn
5. A client arrives at the emergency dept following an explosion at the chemical
plant. He has deep partial and full-thickness chemical burns over more than 25
% of his body surface area. What is the nurse’s priority intervention?
,a. Initiate fluid resuscitation
b. Medication for pain
c. Administer antibiotics
d. Maintain a patent airway
6. A nurse is caring for a client who came the emergency dept reporting chest pain.
The provider suspects a myocardial infarction. While waiting for the laboratory to
report the client’s troponin levels, the client asks what this blood test will show. The
nurse should explain that troponin is
a. An enzyme that indicates damage to brain, heart, and skeletal muscle tissues
b. A protein whose levels reflect the risk for coronary artery disease
c. A heart muscle protein that appears in the bloodstream when there is
damage to the heart
d. A protein that helps transport oxygen throughout the body
7. A nurse is assessing a client who has disseminated intravascular coagulation (DIC).
Which of the following should the nurse expect in the findings?
a. Excessive thrombosis and bleeding
b. Progressive increase in platelet production
c. Immediate sodium and fluid retention
d. Increased clotting factors
8. A nurse is about to administer warfarin (Coumadin) to a client who has atrial
fibrillation. When the client asks what his medication will do, which of the
following is an appropriate nursing response?
a. It helps convert atrial fibrillation to sinus rhythm
b. Is dissolves clots in the bloodstream
c. It slows the response of the ventricles to the fast atrial impulses
d. It prevents strokes in clients who have atrial fibrillation
9. A nurse in a cardiac care unit is caring for a client with acute heart failure. Which
of the following findings should the nurse expect?
a. Decreased brain natriuretic peptide (BNP)
b. Elevated central venous pressure (CVP)
c. Decreased pulmonary pressure
d. Increases urinary output
, 10. mA mclient mcomes minto mthe mED mreporting mnausea mand mvomiting mthat mworsens
mwhen mlying mdown mand mwithout mrelief mfrom mantacids. mThe mprovider msuspects
macute mpancreatitis. mWhich mof m the mfollowing mlab mtest mresults mshould mthe mnurse
mexpect mto msee mif mthe mclient mhas macute mpancreatitis? m
m
a. Decreased mWBC m
b. Increased mserum mamylase m
c. Decreased mserum mlipase m
d. Increased mserum mcalcium m
m
11. mA mnurse min mthe mICU mis mcaring mfor ma mclient mwho mhas macute mrespiratory
mdistress msyndrome m(ARDS) mand mis mreceiving mmechanical mvia man
mendotracheal mtube. mThe mprovider mplans mto m extubate mher mwithin mthe mnext m24
mhour. mWhich mof mthe mfollowing mis man mimportant mcriterion mfor m extubating mthe
mclient? m
m
a. Ability mto mcough meffectively m
b. Adequate mtidal mvolume mwithout mmanually massisted mbreaths m
c. No mindication mof minfection m
d. No mneed mfor msupplemental moxygen m
m
12. mA mnurse mis mcaring mfor ma mclient mfollowing ma mCT mscan mwith mdye mwho msuffered
mfrom man manaphylactic mreaction. mWhich mof mthe mfollowing mconditions mrequires ma
mpriority mnursing mresponse? m
m
a. urticaria m
b. stridor m
c. tachypnea m
d. angioedema m
m
13. mA mnurse mis mcaring mfor ma mfemale mclient mwho mcame min mto mthe mED mreporting
mSOB mand mpain min mthe m lung marea. mHer mheart mrate mis m110/min, mresp. mrate m40/min,
mand mblood m pressure m140/80 mm8juiimHg. mHer m arterial mblood mgases mare: m pH m7.5,
mPaCO2 m 29 mmmHg, mPaO2 m60 mmm mHg, mHCO3 m20 mmEq/L, mand mSaO2 m 86%. mWhich
mof mthe mfollowing mis mthe m priority mintervention? m
m
a. Prepare mfor mmechanical mventilation m
b. Administer moxygen mvia mface mmask m
c. Prepare mto madminister ma msedative m
d. Monitor mfor mpulmonary membolism m
m
14. mA mnurse mis mmonitoring ma mclient mwho mhas mjust mhad ma mthoracentesis mto mremove
mpleural mfluid. mWhich mof mthe mfollowing mclinical mmanifestations mindicate ma
mcomplication mthat mrequires mnotifying mthe mprovider mimmediately? m
m
a. Serosanguineous mdrainage mfrom mthe mpuncture msite m
b. Discomfort mat mthe mpuncture msite m
ANSWERS
1. A nurse in a burn treatment center is caring for a client who is admitted with
severe burns to both lower extremities and is pending an escharotomy. The client’s
spouse asks the nurse what the procedure entails. Which of the following nursing
statements is appropriate?
a. “large incisions will be made in the eschar to improve circulation”
b. “ I can call the doctor back here if you want me to”
c. “a piece of skin will be removed and grafted over the burned area”
d. “dead tissue will be surgically removed”
2. A nurse is monitoring the fluid replacement of a client who has sustained burns.
Which of the following fluids is used in the first 24 hours following a burn injury?
a. 5% dextrose in water
b. 5% dextrose in normal saline
c. normal saline
d. lactated ringers
3. A nurse is caring for a client who has full-thickness burns all over 75% of his
body. Which of the following methods is appropriate to accurately monitor the
cardiovascular system?
a. auscultate cuff blood pressure
b. palpate pulse pressure
c. obtain a central venous pressure
d. monitor the pulmonary artery pressure
4. A nurse is assessing the depth and extent of a client who has severe burns to the
face, neck, and upper extremities. Which of the following factors is the first priority
when assessing the severity of the burn?
a. Age of the client
b. Associated medical history
c. Location of the burn
d. Cause of the burn
5. A client arrives at the emergency dept following an explosion at the chemical
plant. He has deep partial and full-thickness chemical burns over more than 25
% of his body surface area. What is the nurse’s priority intervention?
,a. Initiate fluid resuscitation
b. Medication for pain
c. Administer antibiotics
d. Maintain a patent airway
6. A nurse is caring for a client who came the emergency dept reporting chest pain.
The provider suspects a myocardial infarction. While waiting for the laboratory to
report the client’s troponin levels, the client asks what this blood test will show. The
nurse should explain that troponin is
a. An enzyme that indicates damage to brain, heart, and skeletal muscle tissues
b. A protein whose levels reflect the risk for coronary artery disease
c. A heart muscle protein that appears in the bloodstream when there is
damage to the heart
d. A protein that helps transport oxygen throughout the body
7. A nurse is assessing a client who has disseminated intravascular coagulation (DIC).
Which of the following should the nurse expect in the findings?
a. Excessive thrombosis and bleeding
b. Progressive increase in platelet production
c. Immediate sodium and fluid retention
d. Increased clotting factors
8. A nurse is about to administer warfarin (Coumadin) to a client who has atrial
fibrillation. When the client asks what his medication will do, which of the
following is an appropriate nursing response?
a. It helps convert atrial fibrillation to sinus rhythm
b. Is dissolves clots in the bloodstream
c. It slows the response of the ventricles to the fast atrial impulses
d. It prevents strokes in clients who have atrial fibrillation
9. A nurse in a cardiac care unit is caring for a client with acute heart failure. Which
of the following findings should the nurse expect?
a. Decreased brain natriuretic peptide (BNP)
b. Elevated central venous pressure (CVP)
c. Decreased pulmonary pressure
d. Increases urinary output
, 10. mA mclient mcomes minto mthe mED mreporting mnausea mand mvomiting mthat mworsens
mwhen mlying mdown mand mwithout mrelief mfrom mantacids. mThe mprovider msuspects
macute mpancreatitis. mWhich mof m the mfollowing mlab mtest mresults mshould mthe mnurse
mexpect mto msee mif mthe mclient mhas macute mpancreatitis? m
m
a. Decreased mWBC m
b. Increased mserum mamylase m
c. Decreased mserum mlipase m
d. Increased mserum mcalcium m
m
11. mA mnurse min mthe mICU mis mcaring mfor ma mclient mwho mhas macute mrespiratory
mdistress msyndrome m(ARDS) mand mis mreceiving mmechanical mvia man
mendotracheal mtube. mThe mprovider mplans mto m extubate mher mwithin mthe mnext m24
mhour. mWhich mof mthe mfollowing mis man mimportant mcriterion mfor m extubating mthe
mclient? m
m
a. Ability mto mcough meffectively m
b. Adequate mtidal mvolume mwithout mmanually massisted mbreaths m
c. No mindication mof minfection m
d. No mneed mfor msupplemental moxygen m
m
12. mA mnurse mis mcaring mfor ma mclient mfollowing ma mCT mscan mwith mdye mwho msuffered
mfrom man manaphylactic mreaction. mWhich mof mthe mfollowing mconditions mrequires ma
mpriority mnursing mresponse? m
m
a. urticaria m
b. stridor m
c. tachypnea m
d. angioedema m
m
13. mA mnurse mis mcaring mfor ma mfemale mclient mwho mcame min mto mthe mED mreporting
mSOB mand mpain min mthe m lung marea. mHer mheart mrate mis m110/min, mresp. mrate m40/min,
mand mblood m pressure m140/80 mm8juiimHg. mHer m arterial mblood mgases mare: m pH m7.5,
mPaCO2 m 29 mmmHg, mPaO2 m60 mmm mHg, mHCO3 m20 mmEq/L, mand mSaO2 m 86%. mWhich
mof mthe mfollowing mis mthe m priority mintervention? m
m
a. Prepare mfor mmechanical mventilation m
b. Administer moxygen mvia mface mmask m
c. Prepare mto madminister ma msedative m
d. Monitor mfor mpulmonary membolism m
m
14. mA mnurse mis mmonitoring ma mclient mwho mhas mjust mhad ma mthoracentesis mto mremove
mpleural mfluid. mWhich mof mthe mfollowing mclinical mmanifestations mindicate ma
mcomplication mthat mrequires mnotifying mthe mprovider mimmediately? m
m
a. Serosanguineous mdrainage mfrom mthe mpuncture msite m
b. Discomfort mat mthe mpuncture msite m
