ATI RN MEDSURG 2023/2024 PROCTORED EXAM QUESTIONS AND ANSWERS

Seizure precautions - ANSWERS Ensure client has IV access for seizure medication administration. Postoperative lab values - ANSWERS Report Hgb level of 8 g/dL to provider as an indicator of postoperative hemorrhage or anemia. ESWL procedure - ANSWERS Expect stone fragments in the urine after extracorporeal shock wave lithotripsy. Airborne precautions - ANSWERS Initiate airborne precautions for a client with anorexia, low-grade fever, night sweats, and productive cough, as these are manifestations of tuberculosis. TPN administration - ANSWERS Administer dextrose 10% in water until new TPN bag arrives to avoid drop in blood glucose level. Levothyroxine interaction - ANSWERS Instruct client to avoid taking calcium within 4 hr of levothyroxine administration, as calcium can interfere with the effectiveness of the medication. Mechanical ventilation anxiety - ANSWERS Instruct client to allow the machine to breathe for them to reduce anxiety and restlessness associated with fighting the ventilator. Adverse effect of enalapril - ANSWERS Identify orthostatic hypotension as an adverse effect of enalapril. Delayed wound healing - ANSWERS Identify urine output of 25 mL/hr as a finding that contributes to delayed wound healing. Hypothyroidism and opioid analgesic - ANSWERS Instruct client to void every 4 hours to decrease the risk of urinary retention, which is an adverse effect of opioid analgesics. Portal hypertension - ANSWERS Obtain vital signs first when caring for a client who is vomiting blood mixed with food after a meal, as this indicates a potential rupture of esophageal varices. Gastrectomy postoperative instructions - ANSWERS Instruct client to avoid drinking fluids with meals, eat several small meals per day, consume high-protein snacks, and avoid highly seasoned foods. Cushing's triad - ANSWERS Identify bradycardia as a component of Cushing's triad in a client with increased intracranial pressure from a traumatic brain injury. Client coping with diabetes diagnosis - ANSWERS Recognize the client's change in behavior of inspecting feet daily as an indication of successful coping with the diagnosis. Inguinal hernia assessment - ANSWERS Palpate location C to verify the presence of an inguinal hernia. Rattlesnake bite treatment - ANSWERS Expect a prescription for an opioid analgesic to promote comfort following a rattlesnake bite. Hemodialysis treatment - ANSWERS Perform a 12-lead ECG, place the client in Trendelenburg position, administer a 0.9% sodium chloride 200 mL IV bolus, apply oxygen at 2 L/min via nasal cannula, and notify the provider immediately. Client rights - ANSWERS Ensure a client signs informed consent before receiving a placebo during a research trial. Omeprazole action - ANSWERS Instruct the client that omeprazole provides relief by suppressing gastric acid production. Physical therapy referral - ANSWERS Refer a client who is receiving preoperative teaching for a right knee arthroplasty to physical therapy to begin understanding postoperative exercises and physical restrictions. Droplet precautions - ANSWERS Instruct an assistive personnel (AP) to wear a mask when coming within 3 ft of a client who has bacterial meningitis. Stress incontinence and weight loss - ANSWERS Recommend weight loss to reduce excess abdominal pressure and mitigate the risk of stress incontinence. Hypokalemia and bowel sounds - ANSWERS Expect hypoactive bowel sounds in a client with hypokalemia. Diagnostic results follow-up - ANSWERS Follow up on PCO2 level, WBC count, chest X-ray, and oxygen saturation level. Neurological event follow-up - ANSWERS Follow up on visual disturbances, tingling of the lips, hand grasps, and expressive aphasia. Testicular self-examination - ANSWERS Instruct the client to roll each testicle between the thumb and fingers to feel for any lumps deep in the center of the testicle. Hyperthyroidism assessment - ANSWERS Report blood pressure of 170/80 mm Hg to the provider as a priority finding. Muscle cramps and tingling sensation - ANSWERS Administer calcium carbonate to a client experiencing muscle cramps and tingling sensation in the hands. Seizure intervention - ANSWERS Turn the client to the side during a seizure to prevent aspiration. Medication to withhold prior to cardioversion - ANSWERS Instruct the client to withhold digoxin for 48 hr prior to cardioversion. Sildenafil and nitroglycerin - ANSWERS Inform the client that they cannot use sildenafil if they are taking nitroglycerin due to the risk of significant hypotension. Magnesium sulfate adverse effects - ANSWERS Monitor for respiratory paralysis as an adverse effect of magnesium sulfate. Erythropoietin therapy - ANSWERS Explain that the medication is taken to increase energy levels by increasing hematocrit and reducing fatigue. Chronic glomerulonephritis manifestation - ANSWERS Identify hyperkalemia as a manifestation of chronic glomerulonephritis. Feverfew interaction - ANSWERS Advise the client that naproxen interacts with feverfew and can increase the risk of bleeding. Colorectal cancer risk reduction - ANSWERS Recommend adding cabbage to the diet to help reduce the risk of colorectal cancer. Dysphagia bedside item - ANSWERS Place a suction machine at the client's bedside to clear the airway as needed and reduce the risk of aspiration. Contrast dye assessment - ANSWERS Further assess a client's history of asthma before a CT scan with IV contrast agent due to the risk of a reaction to the dye. Exophthalmos assessment - ANSWERS Identify image D as indicating exophthalmos in a client with Graves' disease. Role change risk - ANSWERS Recognize that a client with multiple sclerosis and progressive difficulty ambulating is at risk for experiencing a role change. Lactulose adverse effect - ANSWERS Identify hypokalemia as an adverse effect of lactulose due to excessive stools.