ATI MEDICAL-SURGICAL NURSING (MED SURG) MASTERY EXAM BANK & STUDY COMPENDIUM 200 HIGH-YIELD NCLEX-STYLE PRACTICE QUESTIONS WITH DETAILED RATIONALES, PRIORITIZATION FRAMEWORKS, CLINICAL JUDGMENT SCENARIOS, AND COMPREHENSIVE COVERAGE OF ADULT HEALTH NURSING

ATI MEDICAL-SURGICAL NURSING (MED SURG) MASTERY EXAM BANK & STUDY COMPENDIUM 200 HIGH-YIELD NCLEX-STYLE PRACTICE QUESTIONS WITH DETAILED RATIONALES, PRIORITIZATION FRAMEWORKS, CLINICAL JUDGMENT SCENARIOS, AND COMPREHENSIVE COVERAGE OF ADULT HEALTH NURSING, PHARMACOLOGY, CARDIOVASCULAR, RESPIRATORY, NEUROLOGICAL, GASTROINTESTINAL, ENDOCRINE, RENAL, HEMATOLOGICAL, IMMUNOLOGICAL, AND POST-OPERATIVE DISORDERS – ALIGNED WITH ATI TESTING BLUEPRINTS AND NCLEX-RN® EXAMINATION GUIDELINES 1. A nurse is caring for a client who is 2 hours post-operative following a thoracotomy. Which of the following assessment findings should be reported to the provider immediately? A. Blood pressure of 110/70 mmHg B. Pain level of 6 on a 0-10 scale C. Respiratory rate of 24 breaths per minute D. Tracheal deviation to the opposite side of the incision CORRECT ANSWER: D. Tracheal deviation to the opposite side of the incision Rationale: Tracheal deviation is a late but critical sign of a tension pneumothorax, which is a medical emergency. The trachea deviates away from the affected side due to increased intrathoracic pressure. The other findings are not immediately life-threatening in this context; respiratory rate of 24 is within normal limits, and pain and blood pressure changes are expected postoperatively. 2. A nurse is preparing to administer digoxin to a client with heart failure. Which of the following findings should indicate to the nurse that the medication should be withheld? A. Heart rate of 58 beats per minute B. Serum potassium of 4.0 mEq/L C. Blood pressure of 118/72 mmHg D. Serum digoxin level of 1.8 ng/mL CORRECT ANSWER: A. Heart rate of 58 beats per minute Rationale: Digoxin slows the heart rate. The medication should be withheld if the apical pulse is below 60 beats per minute (in adults) and the provider should be notified. The potassium level is normal (3.5-5.0 mEq/L), the blood pressure is acceptable, and a digoxin level of 1.8 ng/mL is within the therapeutic range (0.8-2.0 ng/mL). 3. A client with cirrhosis of the liver is exhibiting signs of hepatic encephalopathy. Which of the following dietary modifications is most appropriate for this client? A. High-protein diet B. Low-protein diet C. High-sodium diet D. Low-carbohydrate diet CORRECT ANSWER: B. Low-protein diet Rationale: In hepatic encephalopathy, the liver cannot effectively detoxify ammonia, a byproduct of protein metabolism. A low-protein diet is implemented to reduce the production of ammonia and minimize neurological symptoms. High-protein intake would worsen the condition. 4. A nurse is monitoring a client who is receiving a continuous IV heparin infusion. Which of the following laboratory values indicates that the therapy is therapeutic? A. INR of 2.5 B. aPTT of 60 seconds C. Platelet count of 100,000/mm3 D. PT of 15 seconds CORRECT ANSWER: B. aPTT of 60 seconds Rationale: The therapeutic range for aPTT on heparin therapy is typically 1.5 to 2.5 times the normal control value (usually around 60-80 seconds). INR and PT monitor warfarin therapy, and a platelet count of 100,000 is low and indicates a risk of bleeding but does not measure therapeutic effect. 5. A nurse is providing discharge teaching to a client who has a new prescription for warfarin. Which of the following statements by the client indicates a need for further teaching? A. I will use an electric razor to shave. B. I will eat more green leafy vegetables for extra vitamins. C. I will report any dark, tarry stools to my provider. D. I will take the medication at the same time each day. CORRECT ANSWER: B. I will eat more green leafy vegetables for extra vitamins. Rationale: Green leafy vegetables are high in vitamin K, which antagonizes the effects of warfarin. The client should maintain a consistent intake of vitamin K-rich foods to avoid fluctuating INR levels. The other statements indicate good understanding of safety and adherence. 6. A nurse is assessing a client with a new diagnosis of Addison's disease. Which of the following findings is consistent with this condition? A. Hyperpigmentation of the skin B. Moon face and buffalo hump C. Hyperglycemia D. Weight gain CORRECT ANSWER: A. Hyperpigmentation of the skin Rationale: Addison's disease (primary adrenal insufficiency) is characterized by hyperpigmentation due to increased ACTH levels stimulating melanocytes. Moon face, buffalo hump, hyperglycemia, and weight gain are characteristic of Cushing's syndrome. 7. A client is receiving a blood transfusion and develops chills, fever, and a headache. Which of the following actions should the nurse take first? A. Administer an antihistamine. B. Stop the transfusion. C. Slow the infusion rate. D. Check the client's temperature. CORRECT ANSWER: B. Stop the transfusion. Rationale: These symptoms indicate a febrile non-hemolytic or possible hemolytic transfusion reaction. The priority is to stop the transfusion immediately to prevent further complications. The nurse then notifies the provider, maintains IV access with normal saline, and assesses the client. 8. A nurse is caring for a client with an acute exacerbation of asthma. Which of the following medications should be administered first to relieve acute bronchospasm? A. Salmeterol (Serevent) B. Montelukast (Singulair) C. Albuterol (Proventil) D. Fluticasone (Flovent) CORRECT ANSWER: C. Albuterol (Proventil) Rationale: Albuterol is a short-acting beta2-agonist (SABA) that provides rapid relief of acute bronchospasm by causing bronchodilation. Salmeterol is a long-acting controller medication, montelukast is a leukotriene modifier for chronic management, and fluticasone is an inhaled corticosteroid for inflammation control, none of which are used for immediate relief. 9. A client is post-operative following a thyroidectomy. Which of the following assessment findings should alert the nurse to a possible thyroid crisis (thyroid storm)? A. Hypothermia and bradycardia B. Hypertension and tachycardia C. Lethargy and weight gain D. Hoarseness and difficulty swallowing CORRECT ANSWER: B. Hypertension and tachycardia Rationale: Thyroid storm is a life-threatening hypermetabolic state characterized by severe tachycardia, hypertension, hyperthermia, and agitation. Hypothermia and bradycardia are signs of myxedema coma. Hoarseness and difficulty swallowing may indicate laryngeal nerve damage, not thyroid storm. 10. A nurse is teaching a client about the signs of hypoglycemia. Which of the following symptoms should be included in the teaching? A. Fruity breath odor B. Kussmaul respirations C. Cool, clammy skin D. Polyuria CORRECT ANSWER: C. Cool, clammy skin