ATI Med-Surg proctored Exam review
A nurse is contributing to the plan of care for an older adult client who is postoperative following a right
hip arthroplasty. Which of the following interventions should the nurse include in the plan? - Maintain
abduction of the right hip.
A nurse is caring for a client who has heart failure and respiratory arrest. Which of the following actions
should the nurse take first? - Feel for a carotid pulse.
A nurse is caring for a client scheduled for coronary artery bypass grafting who reports he is no longer
certain he wants to have the procedure. Which of the following responses should the nurse make? -
"Bypass surgery must be very frightening for you."
A nurse is caring for a client after a radical neck dissection. To which of the following should the nurse
give priority in the immediate postoperative period? - Ineffective airway clearance related to thick,
copious secretion
A nurse is contributing to the plan of care for a client who has a spinal cord injury at level C8 who is
admitted for comprehensive rehabilitation. Which of the following long-term goals is appropriate with
regard to the client's mobility? - Propel a wheelchair equipped with knobs on the wheels.
A nurse is reinforcing health teaching about skin cancer with a group of clients. Which of the following
risk factors should the nurse identify as the leading cause of non-melanoma skin cancer? - Sun exposure.
Based on a client's recent history, a nurse suspects that a client is beginning menopause. Which of the
following questions should the nurse ask the client to help confirm the client is experiencing
manifestations of menopause? - "Do you sleep well at night?"
A nurse is reinforcing teaching with a client about cancer prevention and plans to address the
importance of foods high in antioxidants. Which of the following foods should the nurse include in the
teaching? - Fresh berries
,A nurse is assisting with caring for a client who has a new concussion following a motor-vehicle crash.
The nurse should monitor the client for which of the following manifestations of increased intracranial
pressure? - Lethargy
A nurse is reinforcing teaching about a tonometry examination with a client who has manifestations of
glaucoma. Which of the following statements should the nurse include in the teaching? - "This test will
measure the intraocular pressure of the eye."
A nurse is reviewing the laboratory results of a client who is taking cyclosporine following a kidney
transplant. Which of the following laboratory findings should the nurse identify as the most important to
report to the provider? - Increase in serum creatinine
A nurse is checking for paradoxical blood pressure on a client who has constrictive pericarditis. Which of
the following findings should the nurse expect? - Drop in systolic BP more than 10 mm Hg on inspiration
A nurse is caring for a client who has Alzheimer's disease. The nurse discovers the client entering the
room of another client, who becomes upset and frightened. Which of the following actions should the
nurse take? - Attempt to determine what the client was looking for.
A nurse is caring for a client immediately following a cardiac catheterization with a femoral artery
approach. Which of the following actions should the nurse take? - Check pedal pulses every 15 min.
A nurse is assisting with planning an immunization clinic for older adult clients. Which of the following
information should the nurse plan to include about influenza? - The composition of the influenza vaccine
changes yearly.
A nurse is caring for an older adult client who has colon cancer. The client asks the nurse several
questions about his treatment plan. Which of the following actions should the nurse take? - Help the
client write down questions to ask his provider.
A nurse is caring for a client who has hemiplegia following a stroke. The client's adult son is distressed
over his mother's crying and condition. Which of the following responses should the nurse make? - "It
must be hard to see your mother so ill and upset."
A nurse is reinforcing teaching with the family of a client who has primary dementia. Which of the
following manifestations of dementia should the nurse include in the teaching? - Forgetfulness gradually
progressing to disorientation
, A nurse is contributing to the plan of care for a client who has labyrinthitis. Which of the following
interventions should the nurse include in the plan? - Monitor client's cardinal fields of vision.
A nurse is contributing to the plan of care for a client who is admitted with a deep vein thrombosis (DVT)
of the left leg. Which of the following interventions should the nurse include in the plan? - Monitor
platelet levels
A nurse is caring for a client who comes to the clinic to be tested for tuberculosis (TB) after a close family
contact tests positive. Which of the following measures should the nurse anticipate preparing for this
client? - Chest x-ray
A nurse is reviewing data for a client who has a head injury. Which of the following findings should
indicate to the nurse that the client might have diabetes insipidus? - Urine output 650 mL/hr
A nurse is caring for a client who has recurrent kidney stones and a history of diabetes mellitus. The
client is scheduled for an intravenous pyelogram (IVP). The nurse should collect additional data about
which of the following statements made by the client? - "I took my metformin before breakfast."
A nurse is collecting data from a client who is having an acute asthma exacerbation. When auscultating
the client's chest, the nurse should expect to hear which of the following sounds? - Expiratory wheeze
A nurse is caring for a client who is postoperative following foot surgery and is not to bear weight on the
operative foot. The nurse enters the room to discover the client hopped on one foot to the bathroom,
using an IV pole for support. Which of the following actions should the nurse take? - Tell the client to
remain in the bathroom after toileting and obtain a wheelchair.
A nurse is assisting with the care of a client who is postoperative and has a closed-wound drainage system
in place. Which of the following actions should the nurse take? - Fully recollapse the reservoir after
emptying it.
A nurse is reinforcing discharge instructions with a client who has hepatitis A. Which of the following
statements by the client indicates an understanding of the teaching? - "I will abstain from sexual
intercourse."
A nurse is reinforcing discharge teaching on actions that improve gas exchange to a client diagnosed with
emphysema. Which of the following instructions should be included in the teaching? - Breathe in through
her nose and out through pursed lips.
A nurse is contributing to the plan of care for an older adult client who is postoperative following a right
hip arthroplasty. Which of the following interventions should the nurse include in the plan? - Maintain
abduction of the right hip.
A nurse is caring for a client who has heart failure and respiratory arrest. Which of the following actions
should the nurse take first? - Feel for a carotid pulse.
A nurse is caring for a client scheduled for coronary artery bypass grafting who reports he is no longer
certain he wants to have the procedure. Which of the following responses should the nurse make? -
"Bypass surgery must be very frightening for you."
A nurse is caring for a client after a radical neck dissection. To which of the following should the nurse
give priority in the immediate postoperative period? - Ineffective airway clearance related to thick,
copious secretion
A nurse is contributing to the plan of care for a client who has a spinal cord injury at level C8 who is
admitted for comprehensive rehabilitation. Which of the following long-term goals is appropriate with
regard to the client's mobility? - Propel a wheelchair equipped with knobs on the wheels.
A nurse is reinforcing health teaching about skin cancer with a group of clients. Which of the following
risk factors should the nurse identify as the leading cause of non-melanoma skin cancer? - Sun exposure.
Based on a client's recent history, a nurse suspects that a client is beginning menopause. Which of the
following questions should the nurse ask the client to help confirm the client is experiencing
manifestations of menopause? - "Do you sleep well at night?"
A nurse is reinforcing teaching with a client about cancer prevention and plans to address the
importance of foods high in antioxidants. Which of the following foods should the nurse include in the
teaching? - Fresh berries
,A nurse is assisting with caring for a client who has a new concussion following a motor-vehicle crash.
The nurse should monitor the client for which of the following manifestations of increased intracranial
pressure? - Lethargy
A nurse is reinforcing teaching about a tonometry examination with a client who has manifestations of
glaucoma. Which of the following statements should the nurse include in the teaching? - "This test will
measure the intraocular pressure of the eye."
A nurse is reviewing the laboratory results of a client who is taking cyclosporine following a kidney
transplant. Which of the following laboratory findings should the nurse identify as the most important to
report to the provider? - Increase in serum creatinine
A nurse is checking for paradoxical blood pressure on a client who has constrictive pericarditis. Which of
the following findings should the nurse expect? - Drop in systolic BP more than 10 mm Hg on inspiration
A nurse is caring for a client who has Alzheimer's disease. The nurse discovers the client entering the
room of another client, who becomes upset and frightened. Which of the following actions should the
nurse take? - Attempt to determine what the client was looking for.
A nurse is caring for a client immediately following a cardiac catheterization with a femoral artery
approach. Which of the following actions should the nurse take? - Check pedal pulses every 15 min.
A nurse is assisting with planning an immunization clinic for older adult clients. Which of the following
information should the nurse plan to include about influenza? - The composition of the influenza vaccine
changes yearly.
A nurse is caring for an older adult client who has colon cancer. The client asks the nurse several
questions about his treatment plan. Which of the following actions should the nurse take? - Help the
client write down questions to ask his provider.
A nurse is caring for a client who has hemiplegia following a stroke. The client's adult son is distressed
over his mother's crying and condition. Which of the following responses should the nurse make? - "It
must be hard to see your mother so ill and upset."
A nurse is reinforcing teaching with the family of a client who has primary dementia. Which of the
following manifestations of dementia should the nurse include in the teaching? - Forgetfulness gradually
progressing to disorientation
, A nurse is contributing to the plan of care for a client who has labyrinthitis. Which of the following
interventions should the nurse include in the plan? - Monitor client's cardinal fields of vision.
A nurse is contributing to the plan of care for a client who is admitted with a deep vein thrombosis (DVT)
of the left leg. Which of the following interventions should the nurse include in the plan? - Monitor
platelet levels
A nurse is caring for a client who comes to the clinic to be tested for tuberculosis (TB) after a close family
contact tests positive. Which of the following measures should the nurse anticipate preparing for this
client? - Chest x-ray
A nurse is reviewing data for a client who has a head injury. Which of the following findings should
indicate to the nurse that the client might have diabetes insipidus? - Urine output 650 mL/hr
A nurse is caring for a client who has recurrent kidney stones and a history of diabetes mellitus. The
client is scheduled for an intravenous pyelogram (IVP). The nurse should collect additional data about
which of the following statements made by the client? - "I took my metformin before breakfast."
A nurse is collecting data from a client who is having an acute asthma exacerbation. When auscultating
the client's chest, the nurse should expect to hear which of the following sounds? - Expiratory wheeze
A nurse is caring for a client who is postoperative following foot surgery and is not to bear weight on the
operative foot. The nurse enters the room to discover the client hopped on one foot to the bathroom,
using an IV pole for support. Which of the following actions should the nurse take? - Tell the client to
remain in the bathroom after toileting and obtain a wheelchair.
A nurse is assisting with the care of a client who is postoperative and has a closed-wound drainage system
in place. Which of the following actions should the nurse take? - Fully recollapse the reservoir after
emptying it.
A nurse is reinforcing discharge instructions with a client who has hepatitis A. Which of the following
statements by the client indicates an understanding of the teaching? - "I will abstain from sexual
intercourse."
A nurse is reinforcing discharge teaching on actions that improve gas exchange to a client diagnosed with
emphysema. Which of the following instructions should be included in the teaching? - Breathe in through
her nose and out through pursed lips.
