ATI MED SURG PROCTORED WITH NGN EXAM LATEST
VERSION EXAM WITH ACTUAL 210 QUESTION AND CORRECT
DETAILED ANSWERS WITH RATIONALES.
nurse is preparing to administer furosemide to a client who has acute heart
failure. Which of the following laboratory results should the nurse identify as a
contraindication for receiving the medication?
A. Creatinine 0.8 mg/dL
B. Sodium 136 mEq/L
C. Potassium 3.2 mEq/L
D. BUN 18 mg/dL
Correct Answer: C. Potassium 3.2 mEq/L.
Rationale
A potassium level of 3.2 mEq/L is below the normal range of 3.5 to 5.0 mEq/L and
indicates hypokalemia. Furosemide is a loop diuretic that causes potassium
wasting; administering it to a client who is already hypokalemic can further
deplete potassium levels, potentially leading to cardiac arrhythmias. The nurse
should notify the provider and consider potassium supplementation before
administering furosemide. Creatinine of 0.8 mg/dL, sodium of 136 mEq/L, and
BUN of 18 mg/dL are within normal limits and are not contraindications to
furosemide administration.
DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
A nurse on an oncology unit is caring for a client who is receiving internal
radiation therapy. Which of the following actions should the nurse take?
A. Place the dosimeter film badge on the client's door.
B. Wear a lead apron when providing client care.
,C. Leave the door to the client's room open.
D. Allow visitors to hold the client's hand.
Correct Answer: B. Wear a lead apron when providing client care.
Rationale
A lead apron provides protection from radiation exposure when caring for a client
with internal radiation therapy. The dosimeter film badge should be worn by the
nurse, not placed on the client's door, to monitor personal radiation exposure. The
client's door should remain closed to prevent radiation exposure to others.
Visitors should remain at least 6 feet from the client and limit visits to 30 minutes
per day; they should not hold the client's hand.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
A nurse is caring for a client who has diabetes mellitus and has been following a
treatment plan for 3 months. Which of the following results should the nurse
monitor to determine long-term glycemic control?
A. Glycosylated hemoglobin level
B. Fasting blood glucose level
C. Oral glucose tolerance test results
D. Postprandial blood glucose level
Correct Answer: A. Glycosylated hemoglobin level.
Rationale
Glycosylated hemoglobin (HbA1c) reflects average blood glucose levels over the
previous 2 to 3 months and is the best indicator of long-term glycemic control.
Fasting blood glucose and postprandial blood glucose levels reflect immediate
glucose status and can vary daily. Oral glucose tolerance tests are used for
diagnosis, not for monitoring long-term control.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
,A nurse is providing preoperative teaching for a client who is having left-sided
cardiac catheterization. Which of the following information should the nurse
include in the teaching?
A. "You should plan to remain in bed for 18 hours after the procedure."
B. "You will have blood pressure measurement every 5 minutes for the first two
hours after the procedure."
C. "You will receive a general anesthetic during the procedure."
D. "You should expect a warm sensation after the injection of the contrast dye
during the procedure."
Correct Answer: D. "You should expect a warm sensation after the injection of the
contrast dye during the procedure."
Rationale
A warm, flushing sensation is a common and expected response to the injection of
contrast dye during cardiac catheterization. Clients should remain in bed for 4 to 6
hours, not 18 hours, after the procedure depending on the access site and closure
method. Vital signs are monitored frequently but typically not every 5 minutes for
2 hours. Local anesthetic, not general anesthetic, is used for the procedure.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
A nurse is caring for a client who has anemia. Which of the following assessment
findings should the nurse anticipate with the client's condition?
A. Bradycardia
B. Headache
C. Heat intolerance
D. Flushed skin color
Correct Answer: D. Flushed skin color.
, Rationale
Anemia is characterized by a reduced number of red blood cells or hemoglobin,
leading to decreased oxygen-carrying capacity. Flushed skin may be a
manifestation of the body's compensatory response to anemia. Bradycardia is not
typical; tachycardia is more common as the heart attempts to compensate for
reduced oxygen delivery. Headaches and pallor are also common but flushed skin
color is the anticipated finding. Heat intolerance is not associated with anemia.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
A nurse is teaching a client who has a new prescription for warfarin about foods
that affect the INR. The nurse should include in the teaching that which of the
following foods interacts with this medication?
A. Kale
B. Beef stew
C. Yogurt
D. Orange juice
Correct Answer: A. Kale.
Rationale
Kale is a dark leafy green vegetable that is high in vitamin K, which antagonizes the
effects of warfarin and can decrease the INR. Clients taking warfarin should
maintain a consistent intake of vitamin K-rich foods. Beef stew, yogurt, and orange
juice do not significantly interact with warfarin.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
A nurse is planning care for a client who has full-thickness burns on the lower
extremities. Which of the following interventions should the nurse include?
VERSION EXAM WITH ACTUAL 210 QUESTION AND CORRECT
DETAILED ANSWERS WITH RATIONALES.
nurse is preparing to administer furosemide to a client who has acute heart
failure. Which of the following laboratory results should the nurse identify as a
contraindication for receiving the medication?
A. Creatinine 0.8 mg/dL
B. Sodium 136 mEq/L
C. Potassium 3.2 mEq/L
D. BUN 18 mg/dL
Correct Answer: C. Potassium 3.2 mEq/L.
Rationale
A potassium level of 3.2 mEq/L is below the normal range of 3.5 to 5.0 mEq/L and
indicates hypokalemia. Furosemide is a loop diuretic that causes potassium
wasting; administering it to a client who is already hypokalemic can further
deplete potassium levels, potentially leading to cardiac arrhythmias. The nurse
should notify the provider and consider potassium supplementation before
administering furosemide. Creatinine of 0.8 mg/dL, sodium of 136 mEq/L, and
BUN of 18 mg/dL are within normal limits and are not contraindications to
furosemide administration.
DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
A nurse on an oncology unit is caring for a client who is receiving internal
radiation therapy. Which of the following actions should the nurse take?
A. Place the dosimeter film badge on the client's door.
B. Wear a lead apron when providing client care.
,C. Leave the door to the client's room open.
D. Allow visitors to hold the client's hand.
Correct Answer: B. Wear a lead apron when providing client care.
Rationale
A lead apron provides protection from radiation exposure when caring for a client
with internal radiation therapy. The dosimeter film badge should be worn by the
nurse, not placed on the client's door, to monitor personal radiation exposure. The
client's door should remain closed to prevent radiation exposure to others.
Visitors should remain at least 6 feet from the client and limit visits to 30 minutes
per day; they should not hold the client's hand.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
A nurse is caring for a client who has diabetes mellitus and has been following a
treatment plan for 3 months. Which of the following results should the nurse
monitor to determine long-term glycemic control?
A. Glycosylated hemoglobin level
B. Fasting blood glucose level
C. Oral glucose tolerance test results
D. Postprandial blood glucose level
Correct Answer: A. Glycosylated hemoglobin level.
Rationale
Glycosylated hemoglobin (HbA1c) reflects average blood glucose levels over the
previous 2 to 3 months and is the best indicator of long-term glycemic control.
Fasting blood glucose and postprandial blood glucose levels reflect immediate
glucose status and can vary daily. Oral glucose tolerance tests are used for
diagnosis, not for monitoring long-term control.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
,A nurse is providing preoperative teaching for a client who is having left-sided
cardiac catheterization. Which of the following information should the nurse
include in the teaching?
A. "You should plan to remain in bed for 18 hours after the procedure."
B. "You will have blood pressure measurement every 5 minutes for the first two
hours after the procedure."
C. "You will receive a general anesthetic during the procedure."
D. "You should expect a warm sensation after the injection of the contrast dye
during the procedure."
Correct Answer: D. "You should expect a warm sensation after the injection of the
contrast dye during the procedure."
Rationale
A warm, flushing sensation is a common and expected response to the injection of
contrast dye during cardiac catheterization. Clients should remain in bed for 4 to 6
hours, not 18 hours, after the procedure depending on the access site and closure
method. Vital signs are monitored frequently but typically not every 5 minutes for
2 hours. Local anesthetic, not general anesthetic, is used for the procedure.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
A nurse is caring for a client who has anemia. Which of the following assessment
findings should the nurse anticipate with the client's condition?
A. Bradycardia
B. Headache
C. Heat intolerance
D. Flushed skin color
Correct Answer: D. Flushed skin color.
, Rationale
Anemia is characterized by a reduced number of red blood cells or hemoglobin,
leading to decreased oxygen-carrying capacity. Flushed skin may be a
manifestation of the body's compensatory response to anemia. Bradycardia is not
typical; tachycardia is more common as the heart attempts to compensate for
reduced oxygen delivery. Headaches and pallor are also common but flushed skin
color is the anticipated finding. Heat intolerance is not associated with anemia.
DIF: Cognitive Level: Understand (Comprehension)
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
A nurse is teaching a client who has a new prescription for warfarin about foods
that affect the INR. The nurse should include in the teaching that which of the
following foods interacts with this medication?
A. Kale
B. Beef stew
C. Yogurt
D. Orange juice
Correct Answer: A. Kale.
Rationale
Kale is a dark leafy green vegetable that is high in vitamin K, which antagonizes the
effects of warfarin and can decrease the INR. Clients taking warfarin should
maintain a consistent intake of vitamin K-rich foods. Beef stew, yogurt, and orange
juice do not significantly interact with warfarin.
DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
A nurse is planning care for a client who has full-thickness burns on the lower
extremities. Which of the following interventions should the nurse include?
