ATI MISC MED SURG PROCTORED EXAM PRACTICE Updated
2025/2026 WITH CORRECT/ACCURATE ANSWERS
An older adult is brought to an emergency department by a family member. Which of the
following assessment findings should cause the nurse to suspect that the client has hypertonic
dehydration?
Ans: Urine Specific gravity 1.045
A urine specific gravity greater than 1.030 indicates a decrease in urine volume and an increase
in osmolarity, which is a manifestation of hypertonic dehydration.
A nurse in a community clinic is caring for a client who reports an increase in the frequency of
migraine headaches. To help reduce the risk for migraine headaches, which of the following
foods should the nurse recommend the client avoid?
Ans: Aged cheese
Foods that contain tyramine, such as aged cheese and sausage, can trigger migraine headaches.
,A nurse is planning teaching for a client who has bladder cancer and is to undergo a cutaneous
diversion procedure to establish a ureterostomy. Which of the following statements should the
nurse include in the teaching?
Ans: "You should cut the opening of the skin barrier one-eight inch wider than the stoma."
The client should cut the opening of the skin barrier 0.3 cm (1/8in) wider than the stoma to
minimize irritation of the skin from exposure to urine.
A nurse is providing teaching to a client who has hypothyroidism and is receiving levothyroxine.
The nurse should instruct the client that which of the following supplements can interfere with
the effectiveness of the medication?
Ans: Calcium
Calcium limits the development of osteoporosis in clients who are postmenopausal and works
as an antacid. Calcium supplements can interfere with the metabolism of a number of
medications, including levothyroxine. The nurse should instruct the client to avoid taking
calcium within 4 hr of levothyroxine administration.
A nurse is conducting an admission history for a client who is to undergo a CT scan with an IV
contrast agent. The nurse should identify that which of the following findings requires further
assessment?
Ans: History of asthma
A client who has a history of asthma has a greater risk of reacting to the contrast dye used
during the procedure. Other conditions that can result in a reaction to contrast media include
allergies to foods, such as shellfish, eggs, milk, and chocolate.
,A nurse in an ICU is assessing a client who has a traumatic brain injury. Which of the following
findings should the nurse identify as a component of Cushing's triad?
Ans: Bradycardia
A client who has increased intracranial pressure from a traumatic brain injury can develop
bradycardia, which is one component of Cushing's triad. The other components of Cushing's
triad are severe hypertension and a widened pulse pressure.
A nurse is planning to irrigate and dress a clean, granulating wound for a client who has a
pressure injury. Which of the following actions should the nurse take?
Ans: Use a 30-mL syringe
The nurse should use a 30-mL to 60-mL syringe with an 18- or 19- gauge catheter to deliver the
ideal pressure of 8 pounds per square inch (psi) when irrigating a wound. To maintain healthy
granulation tissue, the wound irrigation should be delivered at between 4 and 15 psi.
A nurse in an emergency department is reviewing the provider's prescriptions for a client who
sustained a rattlesnake bite to the lower leg. Which of the following prescriptions should the
expect?
Ans: Administer an opioid analgesic to the client.
The nurse should expect a prescription for an opioid analgesic to promote comfort following a
rattlesnake bite.
, A nurse is reviewing the health record of a client who is scheduled for allergy skin testing. The
nurse should postpone the testing and report to the provider which of the following findings?
(Click on the "Exhibit" button for additional information about the client).
Ans: Current medications
The nurse should review the client's medication record and identify medications, including ACE
inhibitors, beta blockers, theophylline, nifedipine, and glucocorticoids, such as prednisone, that
can alter the allergy skin test results. These medications can diminish the client's reaction to the
allergens. The nurse should notify the provider and instruct the client to discontinue prednisone
for 2 weeks before allergy skin testing.
A nurse is a caring for a client who is on bed rest and has a new prescription for enoxaparin
subcutaneous. Which of the following actions should the nurse take?
Ans: Inject the medication into the anterolateral abdominal wall.
The nurse should inject the medication into the anterolateral or posterolateral abdominal wall
to enhance medication absorption and prevent hematoma formation.
A nurse is caring for a client who has a stage III pressure injury. Which if the following findings
contribute to delayed wound healing?
Ans: Urine output 25 mL/hr
Urinary output reflects fluid status. Inadequate urine output can indicate dehydration, which
can delay wound healing.
2025/2026 WITH CORRECT/ACCURATE ANSWERS
An older adult is brought to an emergency department by a family member. Which of the
following assessment findings should cause the nurse to suspect that the client has hypertonic
dehydration?
Ans: Urine Specific gravity 1.045
A urine specific gravity greater than 1.030 indicates a decrease in urine volume and an increase
in osmolarity, which is a manifestation of hypertonic dehydration.
A nurse in a community clinic is caring for a client who reports an increase in the frequency of
migraine headaches. To help reduce the risk for migraine headaches, which of the following
foods should the nurse recommend the client avoid?
Ans: Aged cheese
Foods that contain tyramine, such as aged cheese and sausage, can trigger migraine headaches.
,A nurse is planning teaching for a client who has bladder cancer and is to undergo a cutaneous
diversion procedure to establish a ureterostomy. Which of the following statements should the
nurse include in the teaching?
Ans: "You should cut the opening of the skin barrier one-eight inch wider than the stoma."
The client should cut the opening of the skin barrier 0.3 cm (1/8in) wider than the stoma to
minimize irritation of the skin from exposure to urine.
A nurse is providing teaching to a client who has hypothyroidism and is receiving levothyroxine.
The nurse should instruct the client that which of the following supplements can interfere with
the effectiveness of the medication?
Ans: Calcium
Calcium limits the development of osteoporosis in clients who are postmenopausal and works
as an antacid. Calcium supplements can interfere with the metabolism of a number of
medications, including levothyroxine. The nurse should instruct the client to avoid taking
calcium within 4 hr of levothyroxine administration.
A nurse is conducting an admission history for a client who is to undergo a CT scan with an IV
contrast agent. The nurse should identify that which of the following findings requires further
assessment?
Ans: History of asthma
A client who has a history of asthma has a greater risk of reacting to the contrast dye used
during the procedure. Other conditions that can result in a reaction to contrast media include
allergies to foods, such as shellfish, eggs, milk, and chocolate.
,A nurse in an ICU is assessing a client who has a traumatic brain injury. Which of the following
findings should the nurse identify as a component of Cushing's triad?
Ans: Bradycardia
A client who has increased intracranial pressure from a traumatic brain injury can develop
bradycardia, which is one component of Cushing's triad. The other components of Cushing's
triad are severe hypertension and a widened pulse pressure.
A nurse is planning to irrigate and dress a clean, granulating wound for a client who has a
pressure injury. Which of the following actions should the nurse take?
Ans: Use a 30-mL syringe
The nurse should use a 30-mL to 60-mL syringe with an 18- or 19- gauge catheter to deliver the
ideal pressure of 8 pounds per square inch (psi) when irrigating a wound. To maintain healthy
granulation tissue, the wound irrigation should be delivered at between 4 and 15 psi.
A nurse in an emergency department is reviewing the provider's prescriptions for a client who
sustained a rattlesnake bite to the lower leg. Which of the following prescriptions should the
expect?
Ans: Administer an opioid analgesic to the client.
The nurse should expect a prescription for an opioid analgesic to promote comfort following a
rattlesnake bite.
, A nurse is reviewing the health record of a client who is scheduled for allergy skin testing. The
nurse should postpone the testing and report to the provider which of the following findings?
(Click on the "Exhibit" button for additional information about the client).
Ans: Current medications
The nurse should review the client's medication record and identify medications, including ACE
inhibitors, beta blockers, theophylline, nifedipine, and glucocorticoids, such as prednisone, that
can alter the allergy skin test results. These medications can diminish the client's reaction to the
allergens. The nurse should notify the provider and instruct the client to discontinue prednisone
for 2 weeks before allergy skin testing.
A nurse is a caring for a client who is on bed rest and has a new prescription for enoxaparin
subcutaneous. Which of the following actions should the nurse take?
Ans: Inject the medication into the anterolateral abdominal wall.
The nurse should inject the medication into the anterolateral or posterolateral abdominal wall
to enhance medication absorption and prevent hematoma formation.
A nurse is caring for a client who has a stage III pressure injury. Which if the following findings
contribute to delayed wound healing?
Ans: Urine output 25 mL/hr
Urinary output reflects fluid status. Inadequate urine output can indicate dehydration, which
can delay wound healing.
