LEGIT ATI RN ADULT MEDICAL-SURGICAL PRACTICE
EXAM CONTAINING ACTUAL AND RETAKE VERSIONS
CURRENT TESTING QUESTIONS ANSWERS|TOP-RATED
A+.
Question 1
A nurse is caring for a client who has heart failure and is receiving IV
furosemide. Which finding requires the nurse's immediate attention?
A. Blood pressure 108/64 mm Hg
B. Urine output of 1,200 mL over 8 hr
C. Serum potassium 2.8 mEq/L
D. Decreased bilateral ankle edema
ANSWER: C. Serum potassium 2.8 mEq/L
Rationale: Furosemide is a loop diuretic that can cause significant potassium
loss. A potassium level of 2.8 mEq/L indicates hypokalemia and increases the
client's risk for life-threatening dysrhythmias. The nurse should notify the
provider and anticipate potassium replacement. The other findings indicate
expected therapeutic responses or are not immediately dangerous.
,Question 2
A nurse is assessing a client who has chronic obstructive pulmonary disease
(COPD). Which finding should the nurse expect?
A. Respiratory rate of 8/min
B. Increased anterior-posterior chest diameter
C. Oxygen saturation of 100% on room air
D. Clear breath sounds throughout the lungs
ANSWER: B. Increased anterior-posterior chest diameter
Rationale: Chronic hyperinflation associated with COPD can produce a barrel-
shaped chest, characterized by an increased anterior-posterior diameter. Clients
commonly have diminished breath sounds, prolonged expiration, and varying
degrees of hypoxemia. A respiratory rate of 8/min is concerning for respiratory
depression.
Question 3
A client with diabetes mellitus reports sweating, tremors, palpitations, and
weakness. The client's blood glucose is 52 mg/dL. Which action should the nurse
take first?
A. Administer 15 g of rapid-acting carbohydrate
B. Administer the client's scheduled insulin
,C. Give the client a high-protein meal
D. Recheck the glucose in 1 hr
ANSWER: A. Administer 15 g of rapid-acting carbohydrate
Rationale: The manifestations indicate symptomatic hypoglycemia. If the client
is conscious and able to swallow, the nurse should administer approximately 15
g of rapid-acting carbohydrate, such as glucose tablets or 4 oz of juice, and
recheck the glucose after about 15 min. Insulin would worsen the hypoglycemia.
Question 4
A nurse is caring for a client who has a chest tube connected to a water-seal
drainage system. Which finding requires intervention?
A. Tidaling in the water-seal chamber
B. Continuous bubbling in the water-seal chamber
C. Drainage of 50 mL during the first hour
D. Occlusive dressing over the insertion site
ANSWER: B. Continuous bubbling in the water-seal chamber
Rationale: Continuous bubbling in the water-seal chamber usually indicates an
air leak in the system. The nurse should assess the tubing, connections, and
insertion site to locate the leak. Tidaling is expected and reflects pressure
changes with respiration.
, Question 5
A nurse is caring for a client who has chronic kidney disease. Which laboratory
value is most important for the nurse to monitor?
A. Hemoglobin A1c
B. Serum creatinine
C. Serum amylase
D. Troponin I
ANSWER: B. Serum creatinine
Rationale: Serum creatinine is a major indicator of kidney function. Clients with
chronic kidney disease require ongoing assessment of renal function because
declining filtration can result in accumulation of metabolic waste, fluid
imbalance, and electrolyte abnormalities.
Question 6
A client is admitted with suspected bacterial meningitis. Which action should
the nurse take?
A. Initiate airborne precautions
B. Place the client in a negative-pressure room
C. Initiate droplet precautions
EXAM CONTAINING ACTUAL AND RETAKE VERSIONS
CURRENT TESTING QUESTIONS ANSWERS|TOP-RATED
A+.
Question 1
A nurse is caring for a client who has heart failure and is receiving IV
furosemide. Which finding requires the nurse's immediate attention?
A. Blood pressure 108/64 mm Hg
B. Urine output of 1,200 mL over 8 hr
C. Serum potassium 2.8 mEq/L
D. Decreased bilateral ankle edema
ANSWER: C. Serum potassium 2.8 mEq/L
Rationale: Furosemide is a loop diuretic that can cause significant potassium
loss. A potassium level of 2.8 mEq/L indicates hypokalemia and increases the
client's risk for life-threatening dysrhythmias. The nurse should notify the
provider and anticipate potassium replacement. The other findings indicate
expected therapeutic responses or are not immediately dangerous.
,Question 2
A nurse is assessing a client who has chronic obstructive pulmonary disease
(COPD). Which finding should the nurse expect?
A. Respiratory rate of 8/min
B. Increased anterior-posterior chest diameter
C. Oxygen saturation of 100% on room air
D. Clear breath sounds throughout the lungs
ANSWER: B. Increased anterior-posterior chest diameter
Rationale: Chronic hyperinflation associated with COPD can produce a barrel-
shaped chest, characterized by an increased anterior-posterior diameter. Clients
commonly have diminished breath sounds, prolonged expiration, and varying
degrees of hypoxemia. A respiratory rate of 8/min is concerning for respiratory
depression.
Question 3
A client with diabetes mellitus reports sweating, tremors, palpitations, and
weakness. The client's blood glucose is 52 mg/dL. Which action should the nurse
take first?
A. Administer 15 g of rapid-acting carbohydrate
B. Administer the client's scheduled insulin
,C. Give the client a high-protein meal
D. Recheck the glucose in 1 hr
ANSWER: A. Administer 15 g of rapid-acting carbohydrate
Rationale: The manifestations indicate symptomatic hypoglycemia. If the client
is conscious and able to swallow, the nurse should administer approximately 15
g of rapid-acting carbohydrate, such as glucose tablets or 4 oz of juice, and
recheck the glucose after about 15 min. Insulin would worsen the hypoglycemia.
Question 4
A nurse is caring for a client who has a chest tube connected to a water-seal
drainage system. Which finding requires intervention?
A. Tidaling in the water-seal chamber
B. Continuous bubbling in the water-seal chamber
C. Drainage of 50 mL during the first hour
D. Occlusive dressing over the insertion site
ANSWER: B. Continuous bubbling in the water-seal chamber
Rationale: Continuous bubbling in the water-seal chamber usually indicates an
air leak in the system. The nurse should assess the tubing, connections, and
insertion site to locate the leak. Tidaling is expected and reflects pressure
changes with respiration.
, Question 5
A nurse is caring for a client who has chronic kidney disease. Which laboratory
value is most important for the nurse to monitor?
A. Hemoglobin A1c
B. Serum creatinine
C. Serum amylase
D. Troponin I
ANSWER: B. Serum creatinine
Rationale: Serum creatinine is a major indicator of kidney function. Clients with
chronic kidney disease require ongoing assessment of renal function because
declining filtration can result in accumulation of metabolic waste, fluid
imbalance, and electrolyte abnormalities.
Question 6
A client is admitted with suspected bacterial meningitis. Which action should
the nurse take?
A. Initiate airborne precautions
B. Place the client in a negative-pressure room
C. Initiate droplet precautions
