ATI MED SURG PROCTORED EXAM
PRACTICE QS & ANS (2024/25) GRADED
A+ / GUARANTEED PASS!!
A charge nurse is observing a newly licensed nurse administer an IV medication to a
client who has an implanted venous access port. Which of the following observations
requires intervention by the charge nurse?
A. A dressing is not applied to the port site after use.
B. A 22-gauge non-coring needle is used to access the port.
C. Blood return is noted prior to administering the medication.
D. A solution of 5 mL heparin 1,000 units/mL has been prepared.
- answers-D. A solution of 5 mL heparin 1,000 units/mL has been prepared.
Implanted ports should be flushed after each use and at least once a month when not in
use. This practice is sometimes referred to as "locking" or "de-accessing." It is
performed to prevent the formation of blood clots in the catheter, which would disrupt
the proper functioning of the catheter. The solution of 5 mL heparin should be 100
units/mL; therefore, this action requires intervention by the charge nurse.
A client is being discharged home with oxygen therapy delivered through a nasal
cannula. Which of the following instructions should the nurse provide to the client and
family members?
A. Use battery-operated equipment for personal care.
B. Apply mineral oil to protect the facial skin from irritation.
C. Remove the television set from the client's bedroom.
D. Wear cotton clothing to avoid static electricity.
- answers-D. Wear cotton clothing to avoid static electricity.
The use of cotton clothing will limit the buildup of static electricity. Oxygen is a highly
combustible gas. The use of oxygen in high concentrations has great combustion
potential and readily fuels fire. Although it will not spontaneously burn or cause an
explosion, it can easily cause a fire in a client's room if it contacts a spark.
A nurse in an emergency department is assessing a client who sustained a fall off of a
roof. Which of the following findings should the nurse identify as an indication of a
basilar skull fracture?
A. Depressed fracture of the forehead
,B. Clear fluid coming from the nares
C. Motor loss on one side of the body
D. Bleeding from the top of the scalp
- answers-B. Clear fluid coming from the nares
Cerebrospinal fluid manifests as a clear fluid coming from the nares or ears, indicating a
basilar skull fracture.
A nurse is assessing a client who has a fractured left femur and is in skeletal traction.
Which of the following findings should the nurse report to the provider?
A. Ecchymosis of the thigh
B. Serous drainage at the pin site
C. Chest petechiae
D. Muscle spasms in the left leg
- answers-C. Chest petechiae
The nurse should identify chest petechiae as an indication of fat embolism syndrome.
Clients who have fractures of the long bones such as the femur are at increased risk of
fat emboli. Fat emboli typically occur 12 to 48 hours after the injury when fat droplets
from the marrow enter into the systemic circulation and are deposited in the lungs. The
nurse should immediately notify the provider because the client could progress to acute
respiratory failure.
A nurse is assessing a client who has cholecystitis. Which of the following findings
should the nurse expect?
A. Blumberg's sign
B. Ascites
C. Gastrointestinal bleeding
D. Kehr's sign
- answers-A. Blumberg's sign
The nurse should expect to find rebound tenderness (Blumberg's sign) in a client who
has cholecystitis. This response can be an indication of peritoneal inflammation.
:B. The nurse should expect to find ascites in a client who has chronic pancreatitis or
pancreatic cancer.
C. The nurse should expect to find gastrointestinal bleeding in a client who has
pancreatic cancer.
D. The nurse should expect to find a positive Kehr's sign in a client who has liver
trauma.
A nurse is assessing a client who has Kaposi's sarcoma. Which of the following findings
should the nurse expect?
, A. Nonproductive cough, fever, and shortness of breath
B. Lesions on the retina that produce blurred vision
C. Onset of progressive dementia
D. Reddish-purple skin lesions
- answers-D. Reddish-purple skin lesions
Kaposi's sarcoma is commonly associated with AIDS and manifests as hyperpigmented
multicentric lesions that can be firm, flat, raised, or nodular. Following a biopsy, the
lesions are treated with radiation and/or chemotherapy.
A nurse is assessing a client who has peripheral vascular disease and a venous ulcer
on the right ankle. Which of the following findings should the nurse expect in the client's
affected extremity?
A. Absent pedal pulses
B. Ankle swelling
C. Hair loss
D. Skin atrophy
- answers-B. Ankle swelling
The nurse should identify that swelling of the ankle is a manifestation of venous
insufficiency due to poor venous return. Other manifestations can include brown
pigmentations and cellulitis.
A nurse is assessing a client who is 12 hr postoperative following an open
cholecystectomy. Which of the following findings should the nurse report to the
provider?
A. Hypoactive bowel sounds
B. Indwelling urinary catheter output of 25 mL/hr
C. Heart rate of 96/min
D. Serous drainage at the surgical incision site
- answers-B. Indwelling urinary catheter output of 25 mL/hr
The nurse should report a urinary output of <30 mL/hr to the provider, as this can
indicate hypovolemia or renal complication.
A nurse is assessing a client who sustained superficial partial-thickness and deep
partial-thickness burns 72 hr ago. Which of the following findings should the nurse
report to the provider?
A. Edema in the burned extremities
B. Severe pain at the burn sites
C. Urine output of 30 mL/hr
D. Temperature of 39.1°C (102.4°F)
- answers-D. Temperature of 39.1°C (102.4°F)
PRACTICE QS & ANS (2024/25) GRADED
A+ / GUARANTEED PASS!!
A charge nurse is observing a newly licensed nurse administer an IV medication to a
client who has an implanted venous access port. Which of the following observations
requires intervention by the charge nurse?
A. A dressing is not applied to the port site after use.
B. A 22-gauge non-coring needle is used to access the port.
C. Blood return is noted prior to administering the medication.
D. A solution of 5 mL heparin 1,000 units/mL has been prepared.
- answers-D. A solution of 5 mL heparin 1,000 units/mL has been prepared.
Implanted ports should be flushed after each use and at least once a month when not in
use. This practice is sometimes referred to as "locking" or "de-accessing." It is
performed to prevent the formation of blood clots in the catheter, which would disrupt
the proper functioning of the catheter. The solution of 5 mL heparin should be 100
units/mL; therefore, this action requires intervention by the charge nurse.
A client is being discharged home with oxygen therapy delivered through a nasal
cannula. Which of the following instructions should the nurse provide to the client and
family members?
A. Use battery-operated equipment for personal care.
B. Apply mineral oil to protect the facial skin from irritation.
C. Remove the television set from the client's bedroom.
D. Wear cotton clothing to avoid static electricity.
- answers-D. Wear cotton clothing to avoid static electricity.
The use of cotton clothing will limit the buildup of static electricity. Oxygen is a highly
combustible gas. The use of oxygen in high concentrations has great combustion
potential and readily fuels fire. Although it will not spontaneously burn or cause an
explosion, it can easily cause a fire in a client's room if it contacts a spark.
A nurse in an emergency department is assessing a client who sustained a fall off of a
roof. Which of the following findings should the nurse identify as an indication of a
basilar skull fracture?
A. Depressed fracture of the forehead
,B. Clear fluid coming from the nares
C. Motor loss on one side of the body
D. Bleeding from the top of the scalp
- answers-B. Clear fluid coming from the nares
Cerebrospinal fluid manifests as a clear fluid coming from the nares or ears, indicating a
basilar skull fracture.
A nurse is assessing a client who has a fractured left femur and is in skeletal traction.
Which of the following findings should the nurse report to the provider?
A. Ecchymosis of the thigh
B. Serous drainage at the pin site
C. Chest petechiae
D. Muscle spasms in the left leg
- answers-C. Chest petechiae
The nurse should identify chest petechiae as an indication of fat embolism syndrome.
Clients who have fractures of the long bones such as the femur are at increased risk of
fat emboli. Fat emboli typically occur 12 to 48 hours after the injury when fat droplets
from the marrow enter into the systemic circulation and are deposited in the lungs. The
nurse should immediately notify the provider because the client could progress to acute
respiratory failure.
A nurse is assessing a client who has cholecystitis. Which of the following findings
should the nurse expect?
A. Blumberg's sign
B. Ascites
C. Gastrointestinal bleeding
D. Kehr's sign
- answers-A. Blumberg's sign
The nurse should expect to find rebound tenderness (Blumberg's sign) in a client who
has cholecystitis. This response can be an indication of peritoneal inflammation.
:B. The nurse should expect to find ascites in a client who has chronic pancreatitis or
pancreatic cancer.
C. The nurse should expect to find gastrointestinal bleeding in a client who has
pancreatic cancer.
D. The nurse should expect to find a positive Kehr's sign in a client who has liver
trauma.
A nurse is assessing a client who has Kaposi's sarcoma. Which of the following findings
should the nurse expect?
, A. Nonproductive cough, fever, and shortness of breath
B. Lesions on the retina that produce blurred vision
C. Onset of progressive dementia
D. Reddish-purple skin lesions
- answers-D. Reddish-purple skin lesions
Kaposi's sarcoma is commonly associated with AIDS and manifests as hyperpigmented
multicentric lesions that can be firm, flat, raised, or nodular. Following a biopsy, the
lesions are treated with radiation and/or chemotherapy.
A nurse is assessing a client who has peripheral vascular disease and a venous ulcer
on the right ankle. Which of the following findings should the nurse expect in the client's
affected extremity?
A. Absent pedal pulses
B. Ankle swelling
C. Hair loss
D. Skin atrophy
- answers-B. Ankle swelling
The nurse should identify that swelling of the ankle is a manifestation of venous
insufficiency due to poor venous return. Other manifestations can include brown
pigmentations and cellulitis.
A nurse is assessing a client who is 12 hr postoperative following an open
cholecystectomy. Which of the following findings should the nurse report to the
provider?
A. Hypoactive bowel sounds
B. Indwelling urinary catheter output of 25 mL/hr
C. Heart rate of 96/min
D. Serous drainage at the surgical incision site
- answers-B. Indwelling urinary catheter output of 25 mL/hr
The nurse should report a urinary output of <30 mL/hr to the provider, as this can
indicate hypovolemia or renal complication.
A nurse is assessing a client who sustained superficial partial-thickness and deep
partial-thickness burns 72 hr ago. Which of the following findings should the nurse
report to the provider?
A. Edema in the burned extremities
B. Severe pain at the burn sites
C. Urine output of 30 mL/hr
D. Temperature of 39.1°C (102.4°F)
- answers-D. Temperature of 39.1°C (102.4°F)
