ATI Medical-Surgical Proctored Exam: REAL EXAM QUESTIONS & VERIFIED ANSWERS - PASS FIRST ATTEMPT GUARANTEED UPDATED QUESTIONS AND 100% ACCURATE ANSWERS | HIGH-LEVEL EXIT EXAM

A nurse in an emergency department is preparing to perform ocular irrigation for a client. Which of the following actions should the nurse plan to take? A. Assess the client's visual acuity prior to starting the irrigation. B. Have the client turn their head toward the unaffected eye. C. Hold the irrigator syringe exactly 3.81 cm (1.5 in) above the eye. D. Perform the irrigation with sterile water or 0.9% sodium chloride for irrigation. Correct Answer: D Rationale: Ocular chemical injuries require immediate flushing to remove contaminants and minimize structural damage or chemical burns. Sterile water or 0.9% normal saline should be used to protect tissues and reduce infection risks. While visual acuity is normally the "sixth vital sign" for eye complaints, immediate irrigation takes physical priority over a visual acuity check during a chemical splash. The client's head must be turned toward the affected side to prevent the contaminated runoff fluid from draining into and damaging the unaffected eye. Question 2 A nurse is preparing to administer Lactated Ringer’s via continuous IV infusion at $200text{ mL/hr}$. The IV tubing has a drop factor of $10text{ drops (gtt)/mL}$. How many gtt/min should the nurse set the manual IV line to administer? (Round your answer to the nearest whole number.) Correct Answer: 33 gtt/min Rationale: To calculate the manual intravenous flow rate in drops per minute, utilize the standard IV drop factor formula: $$text{Flow Rate (gtt/min)} = frac{text{Total Volume (mL)} times text{Drop Factor (gtt/mL)}}{text{Time in Minutes}}$$ Substituting the clinical values into the formula: $$text{Flow Rate} = frac{200text{ mL} times 10text{ gtt/mL}}{60text{ min}} = frac{2000}{60} = 33.33text{ gtt/min}$$ Rounding to the nearest whole number yields 33 gtt/min. Question 3 A nurse is providing discharge teaching to a client who has a new prescription for sublingual nitroglycerin tablets. Which of the following client statements indicates an understanding of the teaching? A. "I can keep my medication safely in my pocket for up to 1 year before replacing it." B. "I should sit or lie down immediately when taking this medication." C. "I should completely discontinue this medication if I develop a headache." D. "I can take up to five tablets in 15 minutes before seeking emergency medical attention." Correct Answer: B Rationale: Nitroglycerin is a potent vasodilator that rapidly lowers systemic vascular resistance, frequently causing orthostatic hypotension, dizziness, and syncope. Sitting or lying down protects the patient from falls. Tablets must be stored in their original dark glass bottle away from light/heat and replaced every 6 months. A headache is an expected side effect of rapid vasodilation and can be treated with acetaminophen. The proper emergency protocol is to take 1 tablet at the onset of chest pain; if pain is unresolved or worsens after 5 minutes, call 911 and take a second tablet (up to a maximum of 3 tablets within 15 minutes). Question 4 A nurse is providing discharge teaching to an older adult client following a left total hip arthroplasty. Which of the following instructions should the nurse include? A. "Clean the surgical incision daily with full-strength hydrogen peroxide." B. "You can safely cross your legs at the ankles when sitting down." C. "You should use your incentive spirometer once every 8 hours." D. "Install a raised toilet seat in your bathroom at home." Correct Answer: D Rationale: Following a total hip arthroplasty, the patient must follow hip precautions to prevent dislocation of the new prosthesis. Installing a raised toilet seat ensures the hip does not flex beyond $90^circ$. Clients must avoid crossing their legs at the knees or ankles (adduction) and avoid twisting. Hydrogen peroxide is cytotoxic and delays wound healing, and an incentive spirometer should be used every 1 to 2 hours while awake to prevent atelectasis. Question 5 A nurse is planning care for a client following a cardiac catheterization via the femoral artery. Which of the following actions should the nurse include in the plan of care? A. Keep the client on strict flat bed rest for 24 hours. B. Limit the client's oral fluid intake to 1 L per day. C. Maintain the client's affected extremity in an extended position. D. Change the sterile pressure dressing over the site every 8 hours. Correct Answer: C Rationale: To prevent arterial cannulation site rupture, hematoma, or severe retroperitoneal hemorrhage, the affected leg must be kept straight and extended for several hours postprocedure. Bed rest is required for only 4 to 6 hours (depending on whether a closure device was used), not 24 hours. Oral or IV fluids should be increased, not restricted, to flush out the nephrotoxic iodinated contrast dye used during the imaging. Question 6 A nurse is caring for a client who has a lower extremity fracture and a new prescription for crutches. Which of the following client statements indicates that the client is adapting successfully to their temporary role change? A. "I will need to have my partner take over shopping for groceries and cooking the meals for us." B. "These crutches will make it completely impossible to care for my child." C. "I feel bad that I have to ask my partner to keep the house clean." D. "It’s going to be difficult to tell my parents I can’t take them to their appointments anymore." Correct Answer: A Rationale: Adapting to a role change caused by a physical limitation requires recognizing boundaries, identifying alternative resources, and reallocating household tasks (delegating responsibilities). Statements reflecting guilt, hopelessness, or complete inability to adjust demonstrate ineffective coping rather than positive adaptation. Question 7 A nurse is caring for a client who has severe gastroenteritis. Which of the following assessment findings should the nurse recognize as an indication that the client is experiencing dehydration? A. Pitting, dependent lower-extremity edema B. Distended jugular veins when sitting at $45^circ$ C. Increased systolic and diastolic blood pressure D. Decreased blood pressure and orthostatic changes Correct Answer: D Rationale: Gastroenteritis causes fluid loss through vomiting and diarrhea, leading to hypovolemia. This manifests as hypotension (low blood pressure), orthostatic vital sign drops, tachycardia, poor skin turgor, dry mucous membranes, and oliguria. Pitting edema, jugular venous distention (JVD), and hypertension are classic indicators of fluid volume excess (overhydration). Question 8 A nurse is caring for a client who has a contusion of the brainstem and reports intense, unquenchable thirst. The client’s urinary output was 4,000 mL over the past 24 hours. The nurse should anticipate a prescription for which of the following medications? A. Desmopressin B. Epinephrine C. Furosemide D. Nitroprusside Correct Answer: A Rationale: A brainstem injury can disrupt the hypothalamus or posterior pituitary gland, arresting the synthesis or release of Antidiuretic Hormone (ADH) and resulting in Central Diabetes Insipidus (DI). DI is characterized by polyuria (excessive excretion of dilute urine) and polydipsia (intense thirst). Desmopressin (DDAVP) is a synthetic form of ADH that restores the kidneys' ability to reabsorb water. Furosemide is a diuretic that would catastrophically worsen the client's dehydration. Question 9 A nurse in a clinic receives a phone call from a client who recently started therapy with an ACE inhibitor and reports a persistent, nagging, dry cough. Which of the following responses by the nurse is appropriate? A. "Your cough is a known side effect and may require us to stop or change your medication." B. "Increasing your daily fluid intake will eliminate your cough entirely." C. "Sucking on a lozenge will cure the underlying cause of your cough." D. "Your cough is temporary and should go away on its own in a few weeks." Correct Answer: A Rationale: Angiotensin-Converting Enzyme (ACE) inhibitors prevent the breakdown of bradykinin and tachykinins in the respiratory tract, which can trigger a localized inflammatory, dry, hacking cough in up to $20%$ of patients. This side effect does not resolve over time and cannot be cured by fluids or throat lozenges. It requires discontinuing the medication and typically switching the client to an Angiotensin II Receptor Blocker (ARB). Question 10 A nurse is taking an admission history from a client who has Raynaud's disease. Which of the following findings should the nurse identify as a potential trigger for exacerbations? A. Consuming a strict vegetarian diet B. A documented history of herpes zoster (shingles) C. Taking amlodipine daily for hypertension D. Using a nicotine transdermal patch for smoking cessation Correct Answer: D Rationale: Raynaud's disease is characterized by episodic digital vasospasms, typically triggered by cold exposure or stress. Nicotine is a potent vasoconstrictor; using nicotine patches or smoking cigarettes directly exacerbates the disease by narrowing peripheral arterioles and severely restricting blood flow to the fingers and toes. Calcium channel blockers, such as amlodipine, are actually used to treat Raynaud's because they promote vasodilation. Question 11 A nurse is caring for a client who has a central venous access device (CVAD) and notes that the IV tubing has become entirely disconnected. The client suddenly develops severe dyspnea, cyanosis, and tachycardia. Which of the following actions should the nurse take first? A. Perform an immediate 12-lead ECG. B. Obtain a blood sample for arterial blood gas (ABG) values. C. Turn the client onto their left side in Trendelenburg position. D. Clamp the catheter lumen. Correct Answer: D Rationale: The client's clinical presentation points to an acute air embolism caused by atmospheric air rushing into the disconnected central line due to negative intrathoracic pressure. Following the nursing process, the absolute priority action is to stop the entry of air by clamping the catheter lumen. Immediately afterward, the nurse should position the client on their left side in Trendelenburg (Durant's maneuver) to trap the air bubble in the apex of the right ventricle, preventing it from blocking the pulmonary artery. Question 12 A nurse is completing a skin assessment of an older adult client and notes localized, nonblanchable reddened areas over the sacrum and heels, but the client's skin is completely intact. Which of the following interventions should the nurse include in the plan of care? A. Turn and reposition the client at least once every 4 hours. B. Apply a tight, occlusive hydrocolloid dressing over the areas. C. Support and offload the bony prominences using pillows or foam wedges. D. Massage the reddened areas vigorously three times a day to increase blood flow. Correct Answer: C Rationale: Intact, non-blanchable redness indicates a Stage 1 pressure injury. The priority intervention is to completely remove mechanical pressure from the site by bridging and offloading the bony prominences with pillows or specialized foam devices ("floating the heels"). Clients in bed must be turned at least every 2 hours, not 4. Massaging reddened areas is strictly contraindicated because it causes deep tissue ischemia and tears fragile capillaries, accelerating tissue breakdown. Question 13 A home health nurse is making an initial assessment visit to a client who has multiple sclerosis (MS). Which of the following actions is the priority for the nurse to take? A. Discuss clinical recommendations for safe eating and swallowing techniques. B. List adaptive coping strategies for the family when dealing with role changes. C. Review the use of specialized adaptive grooming devices to promote independence. D. Provide the client with educational pamphlets regarding the National Multiple Sclerosis Society. Correct Answer: A Rationale: Utilizing Maslow's Hierarchy of Needs and the safety framework, physiological integrity and airway protection take precedence. Multiple sclerosis causes progressive neuromuscular degeneration, frequently resulting in dysphagia (difficulty swallowing), which puts the patient at high risk for silent aspiration and pneumonia. Evaluating cranial nerves, assessing bulbar muscle function, and teaching safe swallowing mechanics are the priority actions. Question 14 A nurse in the emergency department is assessing a client who presents with a chronic cough, hemoptysis, drenching night sweats, and unexpected weight loss. Which of the following actions should the nurse take first? A. Obtain a morning sputum sample for acid-fast bacilli (AFB) culture. B. Administer IV ondansetron for nausea. C. Initiate airborne transmission precautions. D. Prepare the client for a portable chest X-ray. Correct Answer: C Rationale: The client's symptoms are highly characteristic of active pulmonary tuberculosis (TB). To ensure infection control and prevent the transmission of airborne droplet nuclei to healthcare staff and other patients, the nurse's first action must be to place the patient under airborne precautions in a negative-pressure isolation room (AIIR) and wear an N95 respirator. Diagnostic testing and symptom management follow isolation. Question 15 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 a risk factor? A. A personal or family history of Crohn's disease or Ulcerative Colitis. B. A body mass index (BMI) of 24. C. Consuming a diet consistently high in soluble and insoluble fiber. D. Being 46 years of age. Correct Answer: A Rationale: Chronic inflammatory bowel diseases (IBD), such as Crohn's disease and ulcerative colitis, cause continuous mucosal inflammation and cellular epithelial turnover, significantly increasing the risk of colorectal cancer. Protective lifestyle factors include maintaining a healthy weight (BMI 18.5–24.9) and eating a high-fiber diet. Risk increases exponentially after the age of 50.