,ATI RN Medical-Surgical Proctored
Advanced Prep: Master Complex Clinical
Management Practice Questions
Subject: Advanced Medical-Surgical Nursing, Complex Patient Management,
and Prioritization
Question 1: A nurse is caring for a client who is 6 hours post-operative following a total
thyroidectomy. The nurse notes the client has developed a positive Chvostek’s sign and reports
numbness and tingling in the perioral area. Which action should the nurse take first?
A) Administer the prescribed PRN oral calcium supplement.
B) Assess the client’s serum parathyroid hormone (PTH) level.
C) Obtain an order to administer intravenous calcium gluconate.
D) Place the client in a high-Fowler’s position and perform a tracheostomy set-up check.
Correct Answer: C) Obtain an order to administer intravenous calcium gluconate.
Explanation: The client is exhibiting clear signs of acute hypocalcemia, a common complication
of thyroidectomy due to accidental damage or removal of the parathyroid glands. While perioral
tingling and a positive Chvostek’s sign are indicative, the nurse must act rapidly to prevent
tetany and laryngospasm. IV calcium gluconate is the immediate medical intervention required
to restore serum calcium levels rapidly. Oral calcium is too slow for acute management, and
checking PTH (Option B) is diagnostic but not therapeutic for the immediate life-threatening
situation.
Question 2: A client with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation. The high-pressure alarm sounds, and the nurse observes the client’s SpO2 dropping
from 94% to 86%. What is the nurse's priority action?
A) Increase the fraction of inspired oxygen (FiO2) to 100%.
B) Disconnect the ventilator and manually ventilate the client with a resuscitation bag.
C) Suction the endotracheal tube to clear potential airway obstructions.
D) Assess the client for tension pneumothorax and auscultate breath sounds.
Correct Answer: B) Disconnect the ventilator and manually ventilate the client with a
resuscitation bag.
,Explanation: When an alarm sounds and the client shows signs of physiological instability
(desaturation), the nurse must first rule out mechanical ventilator failure. Manually ventilating
the client ensures adequate oxygenation and ventilation while troubleshooting is performed.
Option D is an essential assessment, but immediate airway support takes precedence when the
client’s status is deteriorating rapidly.
Question 3: A nurse is caring for a client with cirrhosis who has developed ascites. The provider
prescribes spironolactone and furosemide. The client’s laboratory results show a serum
potassium level of 5.8 mEq/L. Which action should the nurse take?
A) Administer both medications as prescribed.
B) Withhold the furosemide but administer the spironolactone.
C) Withhold both medications and notify the provider.
D) Administer the furosemide but withhold the spironolactone.
Correct Answer: D) Administer the furosemide but withhold the spironolactone.
Explanation: Spironolactone is a potassium-sparing diuretic, whereas furosemide is a
potassium-wasting loop diuretic. With a serum potassium of 5.8 mEq/L (hyperkalemia), the
spironolactone poses a high risk for life-threatening cardiac arrhythmias. Furosemide may still
be indicated to manage the ascites and potentially help lower the potassium level. Withholding
both (Option C) fails to address the fluid volume excess, but continuing the potassium-sparing
agent is clinically unsafe.
Question 4: A nurse is managing a client with syndrome of inappropriate antidiuretic hormone
(SIADH). The nurse should anticipate which of the following assessment findings?
A) Serum sodium 125 mEq/L and urine specific gravity 1.035.
B) Serum sodium 145 mEq/L and urine specific gravity 1.005.
C) Serum sodium 125 mEq/L and urine specific gravity 1.005.
D) Serum sodium 150 mEq/L and urine specific gravity 1.030.
Correct Answer: A) Serum sodium 125 mEq/L and urine specific gravity 1.035.
Explanation: SIADH is characterized by excessive ADH release, leading to water retention,
dilutional hyponatremia (low serum sodium), and the excretion of concentrated urine (high urine
specific gravity). Option C describes diluted urine, and options B and D reflect hypernatremia,
which is inconsistent with the pathophysiology of SIADH.
, Question 5: A nurse is caring for a client with a suspected pheochromocytoma. Which
intervention should be prioritized when preparing for diagnostic testing?
A) Encourage a high-sodium, high-caffeine diet.
B) Avoid palpating the abdomen.
C) Administer a histamine injection to provoke symptoms.
D) Prepare for an emergency cholecystectomy.
Correct Answer: B) Avoid palpating the abdomen.
Explanation: Pheochromocytoma is a catecholamine-secreting tumor of the adrenal medulla.
Manipulating or palpating the abdomen can trigger a massive release of catecholamines,
leading to a life-threatening hypertensive crisis. Caffeine (Option A) also stimulates
catecholamine release and is contraindicated. Histamine (Option C) is a historical test that is
rarely used due to extreme safety risks.
Question 6: A client with heart failure is receiving an infusion of milrinone. Which assessment
finding is most important for the nurse to prioritize?
A) Monitoring the infusion site for phlebitis.
B) Continuous ECG monitoring for ventricular dysrhythmias.
C) Daily weight monitoring.
D) Assessing for improvement in bilateral peripheral edema.
Correct Answer: B) Continuous ECG monitoring for ventricular dysrhythmias.
Explanation: Milrinone is a phosphodiesterase inhibitor that increases myocardial contractility
and promotes vasodilation. A major adverse effect is severe cardiac dysrhythmias, particularly
ventricular tachycardia or fibrillation. While weight and edema (Options C and D) are
important for long-term management, the immediate safety priority with IV inotropic agents is
hemodynamic stability and rhythm monitoring.
Question 7: A nurse is caring for a client in the recovery room after a modified radical
mastectomy. The client’s Jackson-Pratt drain output has changed from 30 mL of
serosanguineous fluid to 60 mL of bright red blood over the last hour. What is the nurse's priority
action?
A) Document the finding as a normal post-operative occurrence.
B) Increase the suction on the Jackson-Pratt drain.
Advanced Prep: Master Complex Clinical
Management Practice Questions
Subject: Advanced Medical-Surgical Nursing, Complex Patient Management,
and Prioritization
Question 1: A nurse is caring for a client who is 6 hours post-operative following a total
thyroidectomy. The nurse notes the client has developed a positive Chvostek’s sign and reports
numbness and tingling in the perioral area. Which action should the nurse take first?
A) Administer the prescribed PRN oral calcium supplement.
B) Assess the client’s serum parathyroid hormone (PTH) level.
C) Obtain an order to administer intravenous calcium gluconate.
D) Place the client in a high-Fowler’s position and perform a tracheostomy set-up check.
Correct Answer: C) Obtain an order to administer intravenous calcium gluconate.
Explanation: The client is exhibiting clear signs of acute hypocalcemia, a common complication
of thyroidectomy due to accidental damage or removal of the parathyroid glands. While perioral
tingling and a positive Chvostek’s sign are indicative, the nurse must act rapidly to prevent
tetany and laryngospasm. IV calcium gluconate is the immediate medical intervention required
to restore serum calcium levels rapidly. Oral calcium is too slow for acute management, and
checking PTH (Option B) is diagnostic but not therapeutic for the immediate life-threatening
situation.
Question 2: A client with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation. The high-pressure alarm sounds, and the nurse observes the client’s SpO2 dropping
from 94% to 86%. What is the nurse's priority action?
A) Increase the fraction of inspired oxygen (FiO2) to 100%.
B) Disconnect the ventilator and manually ventilate the client with a resuscitation bag.
C) Suction the endotracheal tube to clear potential airway obstructions.
D) Assess the client for tension pneumothorax and auscultate breath sounds.
Correct Answer: B) Disconnect the ventilator and manually ventilate the client with a
resuscitation bag.
,Explanation: When an alarm sounds and the client shows signs of physiological instability
(desaturation), the nurse must first rule out mechanical ventilator failure. Manually ventilating
the client ensures adequate oxygenation and ventilation while troubleshooting is performed.
Option D is an essential assessment, but immediate airway support takes precedence when the
client’s status is deteriorating rapidly.
Question 3: A nurse is caring for a client with cirrhosis who has developed ascites. The provider
prescribes spironolactone and furosemide. The client’s laboratory results show a serum
potassium level of 5.8 mEq/L. Which action should the nurse take?
A) Administer both medications as prescribed.
B) Withhold the furosemide but administer the spironolactone.
C) Withhold both medications and notify the provider.
D) Administer the furosemide but withhold the spironolactone.
Correct Answer: D) Administer the furosemide but withhold the spironolactone.
Explanation: Spironolactone is a potassium-sparing diuretic, whereas furosemide is a
potassium-wasting loop diuretic. With a serum potassium of 5.8 mEq/L (hyperkalemia), the
spironolactone poses a high risk for life-threatening cardiac arrhythmias. Furosemide may still
be indicated to manage the ascites and potentially help lower the potassium level. Withholding
both (Option C) fails to address the fluid volume excess, but continuing the potassium-sparing
agent is clinically unsafe.
Question 4: A nurse is managing a client with syndrome of inappropriate antidiuretic hormone
(SIADH). The nurse should anticipate which of the following assessment findings?
A) Serum sodium 125 mEq/L and urine specific gravity 1.035.
B) Serum sodium 145 mEq/L and urine specific gravity 1.005.
C) Serum sodium 125 mEq/L and urine specific gravity 1.005.
D) Serum sodium 150 mEq/L and urine specific gravity 1.030.
Correct Answer: A) Serum sodium 125 mEq/L and urine specific gravity 1.035.
Explanation: SIADH is characterized by excessive ADH release, leading to water retention,
dilutional hyponatremia (low serum sodium), and the excretion of concentrated urine (high urine
specific gravity). Option C describes diluted urine, and options B and D reflect hypernatremia,
which is inconsistent with the pathophysiology of SIADH.
, Question 5: A nurse is caring for a client with a suspected pheochromocytoma. Which
intervention should be prioritized when preparing for diagnostic testing?
A) Encourage a high-sodium, high-caffeine diet.
B) Avoid palpating the abdomen.
C) Administer a histamine injection to provoke symptoms.
D) Prepare for an emergency cholecystectomy.
Correct Answer: B) Avoid palpating the abdomen.
Explanation: Pheochromocytoma is a catecholamine-secreting tumor of the adrenal medulla.
Manipulating or palpating the abdomen can trigger a massive release of catecholamines,
leading to a life-threatening hypertensive crisis. Caffeine (Option A) also stimulates
catecholamine release and is contraindicated. Histamine (Option C) is a historical test that is
rarely used due to extreme safety risks.
Question 6: A client with heart failure is receiving an infusion of milrinone. Which assessment
finding is most important for the nurse to prioritize?
A) Monitoring the infusion site for phlebitis.
B) Continuous ECG monitoring for ventricular dysrhythmias.
C) Daily weight monitoring.
D) Assessing for improvement in bilateral peripheral edema.
Correct Answer: B) Continuous ECG monitoring for ventricular dysrhythmias.
Explanation: Milrinone is a phosphodiesterase inhibitor that increases myocardial contractility
and promotes vasodilation. A major adverse effect is severe cardiac dysrhythmias, particularly
ventricular tachycardia or fibrillation. While weight and edema (Options C and D) are
important for long-term management, the immediate safety priority with IV inotropic agents is
hemodynamic stability and rhythm monitoring.
Question 7: A nurse is caring for a client in the recovery room after a modified radical
mastectomy. The client’s Jackson-Pratt drain output has changed from 30 mL of
serosanguineous fluid to 60 mL of bright red blood over the last hour. What is the nurse's priority
action?
A) Document the finding as a normal post-operative occurrence.
B) Increase the suction on the Jackson-Pratt drain.
