ATI Med-Surg Proctored Exam 2024-2025 |
Accurate Questions & Detailed Answers |
Guaranteed Pass | Graded A | Latest
Update
A nurse is providing discharge instructions to a client who has laryngeal cancer and is receiving
radiation therapy. Which of the following statements by the client indicates an understanding of
the teaching?
A. I will wear a badge to measure how much radiation I am receiving
B. I will remove the markings on my skin after each radiation treatment
C. I will avoid direct exposure to the sun
D. I will rinse my mouth with a commercial mouthwash
- ANSWER C
Should avoid exposure of irradiated skin areas to the sun for at least 1 year after completing
radiation therapy because skin in the radiation path is especially sensitive to sun damage.
Healthcare workers who care for the client should wear a dosimeter badge to measure radiation
exposure. The client should not remove the markings until the course of radiation is complete
because radiation marking ensure consistent dose delivery to the targeted area.Head and neck
radiation can damage salivary glands and cause dry mouth, which predisposes the client to
mucositis. Should rinse with plain water or NS.
A nurse is providing teaching to a client who has anemia and a new prescription for an oral iron
supplement. Which of the following statements by the client indicates an understanding of the
teaching?
A. I will take my iron with a glass of milk
B. I will take an antacid with my iron
C. I will limit my intake of red meat
D. I will eat more high-fiber foods
- ANSWER D
,High-fiber foods to prevent constipation, which is a common adverse effect of oral iron
supplements. Dairy products and antacids inhibit the absorption of iron. Should increase intake
of red meat because it is high in iron and will supplement this medication.
A nurse is caring for a client who has a positive culture for MRSA. Which of the following actions
should the nurse take?
A. Obtain a sputum specimen to determine if there is colonization
B. Bathe the client using chlorhexidine solution
C. Place the client in a droplet isolation
D. Restrict visits from the client's friends and family
- ANSWER B
Bathe the client using chlorhexidine solution because it reduces the risk of transmission of
MRSA to other areas of the body. Obtain a nasal specimen to determine if there is colonization.
Place client in contact isolation. Do not need to restrict client's visitors, but they should wear
gowns and gloves.
A PACU nurse is assessing a client who is postoperative following a right nephrectomy. The
client's initial vital signs were HR 80/min, BP 130/70mmHg, RR 16/min, and temperature 36ºC
(96.8ºF). Which of the following vital sign changes should alert the nurse that the client might
be hemorrhaging?
A. HR 110/min
B. BP 160/70mmHg
C. RR 14/min
D. Temperature 38.4ºC (101.1ºF)
- ANSWER A
One of the first signs of hemorrhage is an increase in HR from the client's baseline to
compensate for blood loss. Early sign of hemorrhage is a slight increase in diastolic BP, but as
bleeding progresses, the systolic BP will decrease. An increase in BP postoperatively can indicate
that the client is in pain. Increase in RR indicates hemorrhage. Increase in temperature indicates
infection.
,A nurse is updating the plan of care for a client who is receiving chemotherapy. Which of the
following findings should the nurse identify as the priority?
A. Report of sore throat
B. Report of memory loss
C. Alopecia
D. Mucositis
- ANSWER A
Could be a manifestation of an infection. The client is at risk for neutropenia due to
myelosuppression, and therefore an infection could lead to sepsis. Memory loss, alopecia, and
mucositis are expected findings.
A nurse is preparing to administer a blood transfusion to a client who has anemia. Which of the
following actions should the nurse take first?
A. Obtain the client's vital signs
B. Describe the blood transfusion procedure to the client
C. Check for the type and number of units of blood to administer
D. Initiate a peripheral IV line
- ANSWER C
Should first confirm the type and number of units of blood to administer matches what is
indicated in the client's chart. Vital signs, description of procedure, and large-bore IV access to
prevent hemolysis after confirmation.
A nurse is checking the ECG rhythm strip for a client who has a temporary pacemaker. The nurse
notes a pacemaker artifact followed by a QRS complex. Which of the following actions should
the nurse take?
A. Document that depolarization has occurred
B. Increase the pacemaker's voltage
C. Decrease the pacemaker's sensitivity
D. Check the placement of the ECG leads
- ANSWER A
, Spike followed by a QRS complex indicates pacing stimulus was delivered to the ventricle and
caused depolarization. Pacemaker is firing correctly and has adequate voltage.
A nurse is planning care for a client who is postoperative following a parathyroidectomy. Which
of the following actions should the nurse identify as the priority?
A. Use pillows to support the client's head and neck
B. Offer opioid medication
C. Place a tracheostomy tray at the bedside
D. Place the client in semi-Fowler's position
- ANSWER C
Priority following ABC, in case of airway obstruction. Should use pillows, offer opioid
medication, and place in semi-Fowler's, but they are not the priority.
A nurse is planning care for a client who is scheduled for a thoracentesis. Which of the following
interventions should the nurse include in the plan?
A. Encourage the client to take deep breaths after the procedure
B. Assist the client to hold arms up during the procedure
C. Instruct the client to remain NPO after midnight prior to the procedure
D. Keep the client on bed rest for 8 hr following the procedure
- ANSWER A
Should deep breath to re-expand the lung. Should be placed in an upright position with arms
resting on an overhead table to widen the intercostal space and spread the ribs for tube
insertion. Should assist a client who cannot sit up into a side-lying position with the affected
side up. Received local anesthetic so will not require NPO. Can resume activity within 1 hr
following the procedure.
A nurse is assessing a client who is postoperative following a thyroidectomy. Which of the
following findings is the nurse's priority?
A. Moderate serosanguinous drainage on the dressing
B. Calcium 9.5 mg/dL
Accurate Questions & Detailed Answers |
Guaranteed Pass | Graded A | Latest
Update
A nurse is providing discharge instructions to a client who has laryngeal cancer and is receiving
radiation therapy. Which of the following statements by the client indicates an understanding of
the teaching?
A. I will wear a badge to measure how much radiation I am receiving
B. I will remove the markings on my skin after each radiation treatment
C. I will avoid direct exposure to the sun
D. I will rinse my mouth with a commercial mouthwash
- ANSWER C
Should avoid exposure of irradiated skin areas to the sun for at least 1 year after completing
radiation therapy because skin in the radiation path is especially sensitive to sun damage.
Healthcare workers who care for the client should wear a dosimeter badge to measure radiation
exposure. The client should not remove the markings until the course of radiation is complete
because radiation marking ensure consistent dose delivery to the targeted area.Head and neck
radiation can damage salivary glands and cause dry mouth, which predisposes the client to
mucositis. Should rinse with plain water or NS.
A nurse is providing teaching to a client who has anemia and a new prescription for an oral iron
supplement. Which of the following statements by the client indicates an understanding of the
teaching?
A. I will take my iron with a glass of milk
B. I will take an antacid with my iron
C. I will limit my intake of red meat
D. I will eat more high-fiber foods
- ANSWER D
,High-fiber foods to prevent constipation, which is a common adverse effect of oral iron
supplements. Dairy products and antacids inhibit the absorption of iron. Should increase intake
of red meat because it is high in iron and will supplement this medication.
A nurse is caring for a client who has a positive culture for MRSA. Which of the following actions
should the nurse take?
A. Obtain a sputum specimen to determine if there is colonization
B. Bathe the client using chlorhexidine solution
C. Place the client in a droplet isolation
D. Restrict visits from the client's friends and family
- ANSWER B
Bathe the client using chlorhexidine solution because it reduces the risk of transmission of
MRSA to other areas of the body. Obtain a nasal specimen to determine if there is colonization.
Place client in contact isolation. Do not need to restrict client's visitors, but they should wear
gowns and gloves.
A PACU nurse is assessing a client who is postoperative following a right nephrectomy. The
client's initial vital signs were HR 80/min, BP 130/70mmHg, RR 16/min, and temperature 36ºC
(96.8ºF). Which of the following vital sign changes should alert the nurse that the client might
be hemorrhaging?
A. HR 110/min
B. BP 160/70mmHg
C. RR 14/min
D. Temperature 38.4ºC (101.1ºF)
- ANSWER A
One of the first signs of hemorrhage is an increase in HR from the client's baseline to
compensate for blood loss. Early sign of hemorrhage is a slight increase in diastolic BP, but as
bleeding progresses, the systolic BP will decrease. An increase in BP postoperatively can indicate
that the client is in pain. Increase in RR indicates hemorrhage. Increase in temperature indicates
infection.
,A nurse is updating the plan of care for a client who is receiving chemotherapy. Which of the
following findings should the nurse identify as the priority?
A. Report of sore throat
B. Report of memory loss
C. Alopecia
D. Mucositis
- ANSWER A
Could be a manifestation of an infection. The client is at risk for neutropenia due to
myelosuppression, and therefore an infection could lead to sepsis. Memory loss, alopecia, and
mucositis are expected findings.
A nurse is preparing to administer a blood transfusion to a client who has anemia. Which of the
following actions should the nurse take first?
A. Obtain the client's vital signs
B. Describe the blood transfusion procedure to the client
C. Check for the type and number of units of blood to administer
D. Initiate a peripheral IV line
- ANSWER C
Should first confirm the type and number of units of blood to administer matches what is
indicated in the client's chart. Vital signs, description of procedure, and large-bore IV access to
prevent hemolysis after confirmation.
A nurse is checking the ECG rhythm strip for a client who has a temporary pacemaker. The nurse
notes a pacemaker artifact followed by a QRS complex. Which of the following actions should
the nurse take?
A. Document that depolarization has occurred
B. Increase the pacemaker's voltage
C. Decrease the pacemaker's sensitivity
D. Check the placement of the ECG leads
- ANSWER A
, Spike followed by a QRS complex indicates pacing stimulus was delivered to the ventricle and
caused depolarization. Pacemaker is firing correctly and has adequate voltage.
A nurse is planning care for a client who is postoperative following a parathyroidectomy. Which
of the following actions should the nurse identify as the priority?
A. Use pillows to support the client's head and neck
B. Offer opioid medication
C. Place a tracheostomy tray at the bedside
D. Place the client in semi-Fowler's position
- ANSWER C
Priority following ABC, in case of airway obstruction. Should use pillows, offer opioid
medication, and place in semi-Fowler's, but they are not the priority.
A nurse is planning care for a client who is scheduled for a thoracentesis. Which of the following
interventions should the nurse include in the plan?
A. Encourage the client to take deep breaths after the procedure
B. Assist the client to hold arms up during the procedure
C. Instruct the client to remain NPO after midnight prior to the procedure
D. Keep the client on bed rest for 8 hr following the procedure
- ANSWER A
Should deep breath to re-expand the lung. Should be placed in an upright position with arms
resting on an overhead table to widen the intercostal space and spread the ribs for tube
insertion. Should assist a client who cannot sit up into a side-lying position with the affected
side up. Received local anesthetic so will not require NPO. Can resume activity within 1 hr
following the procedure.
A nurse is assessing a client who is postoperative following a thyroidectomy. Which of the
following findings is the nurse's priority?
A. Moderate serosanguinous drainage on the dressing
B. Calcium 9.5 mg/dL
