ATI Med Surg Proctored Exam (CMS)

1. A nurse is assessing a client who is 12hr postoperative following a colon resection. Which of the following findings should the nurse report to the surgeon? - Hgb 8.2 g/dl 2. A nurse is caring for a client who has diabetes insipidus. Which of the following medications should the nurse plan to administer? - Desmopressin 3. A nurse is admitting a client who has arthritic pain and reports taking ibuprofen several times daily for 3 years. Which of the following test should the nurse monitor? - Stool for occult blood - GI bleed 4. A nurse in the emergency department is assessing a client. Which of the following actions should the nurse take first - Initiate airborne precautions 5. A nurse is contacting the provider for a client who has cancer and is experiencing breakthrough pain. Which of the following prescriptions should the nurse anticipate? - Transmucosal fentany 6. A nurse is admitting a client who reports chest pain and has been placed on a telemetry monitor. Which of the following should the nurse analyze to determine whether the client is experiencing a myocardial infarction? - ST segment 7. A nurse is teaching a client who has ovarian cancer about skin care following radiation treatment. Which of the following instructions should the nurse include? - Pat the skin on the radiation site to dry it 8. A nurse is caring for a client who is receiving a blood transfusion. The nurse observes that the client has bounding peripheral pulses, hypertension, and distended jugular veins. The nurse should anticipate administering which of the following prescribed medications? - Furosemide 9. A nurse is assessing a client who is receiving magnesium sulfate IV for the treatment of hypomagnesemia. Which of the following findings indicates effectiveness of the medication? - Apical pulse 82/min 10. A nurse is reviewing a client's ABG results pH 7.42, PaC02 30 mm Hg, and HCO3 21 mEq/L. The nurse should recognize these findings as indication of which of the following conditions? - Compensated respiratory alkalosis 11. A nurse is caring for a client who has a deep partial thickness burns over 15% of her body which of the following labs should the nurse expect during the first 24 hours - Hypoalbuminemia (Low due to fluid loss) 12. A nurse is caring for a client who has dumping syndrome following a gastrectomy, which of the following actions should the nurse takes? - Have the client lie down for 30 minutes after meals (Lying down after a meal slows the movement of food within the intestines) 13. A nurse is preparing to administer fresh frozen plasma to a client. Which of the following actions should the nurse take? - Administer the plasma immediately after thawing 14. A nurse is assessing a client who reports numbness and tingling of his toes and exhibits a positive TROUSSEAU. Which of the following electrolyte imbalance should the nurse suspect? - Hypocalcemia 15. A home health nurse is teaching a client how to care for a peripherally central catheter in his right arm. Which of the following statements should the nurse include in the teaching? - Use a 10-milliliter syringe when flushing the catheter 16. A nurse is caring for a client who has a central venous access device. Which of the following assessment findings should the nurse report to the provider? - WBC count of 16,000/ mm 17. A nurse is providing dietary teaching to a client who has chronic kidney disease and a decreased glomerular filtration rate. Which of the following statements by the client indicates an understanding of the teaching? - I will spread my protein allowances over the entire day 18. A nurse is caring for a client who has a peripherally inserted central catheter. The client is receiving an antibiotic via intermittent IV bolus. Which of the following actions should the nurse take? - Verify the placement with an x-ray prior to the initial dose 19. A nurse is teaching a client using a metered dose rescue inhaler. Which of the following statements should the nurse include in the teaching? - Exhale fully before bringing the inhaler to your lips 20. A nurse is assessing the pain status of a group of clients. Which of the following findings indicate a client is experiencing referred pain? - A client who has pancreatitis reports pain in the left shoulder 21. A nurse is caring for a client who has just returned from surgery with an external fixator to the left tibia. Which of the following assessments findings requires immediate intervention by the nurse? - The client's capillary refill in the left toe is 6 seconds (signs and symptoms of compartment syndrome) 22. A nurse is assessing a client who has acute pancreatitis and has been receiving total parenteral nutrition for the past 72 hours. Which of the following findings requires the nurse to intervene? - Crackle in bilateral lower lobes 23. A nurse is caring for a client who has hypotension, cool and clammy skin, tachycardia, and tachypnea. In which of the following positions should the nurse place the client? - Feet elevated 24. A nurse is caring for a client who has tuberculosis and is taking rifampin. The client reports that her saliva has turned red orange in color. Which of the following responses should the nurse make? - "This is an expected adverse effect of this medication. 25. A nurse is preparing to administer a unit of packed RBCs for a client who is receiving a continuous IV infusion of 5% dextrose in water. Which of the following actions should the nurse take? - Begin an IV infusion of 0.9% sodium chloride 26. A nurse is planning care for a client who is 12 hr. postoperative following a kidney transplant. Which of the following actions should the nurse include in the plan of care? - Assess urine output hourly ---à prevent shock and mods 27..A nurse is teaching a group of young adult clients about risk factors for hearing loss. Which of the following factors should the nurse include in the teaching? – Chronic infections of the middle ear Use a loop diuretic Perforation of the eardrum 28.A nurse is obtaining a medication history from a client who is to start therapy with naproxen for rheumatoid arthritis. Which of the following medications places the client at risk for bleeding? - Ibuprofen --NSAIDs 29.A nurse is assessing the extremities of a client who has Raynaud's disease. Which of the following findings should the nurse expect? - Blanching of the hands REYNAUD PHENOMENON 30.A nurse is caring for a group of clients. The nurse should obtain a blood pressure reading using only the left extremity from which of the following clients? - A client who has a right upper extremity arteriovenous fistula 31.A nurse is providing teaching to a client who has DVT. Which of the following findings should the nurse identify as a risk factor for the development of DVTs? - Oral Contraceptive Use 32.A nurse is caring for client who has Cushing's disease. Which of the following actions should the nurse take first? - Auscultate the client's lung sound - due to fluid retention; action first varies on the exhibit 33.A nurse is assessing a client who has nephrotic syndrome. Which of the findings should the nurse expect? - Proteinuria 34.A nurse is assessing a client who has right-sided heart failure. Which of the following assessment findings should the nurse expect to find? - Pitting edema 35.A nurse is caring for a client who has newly inserted chest tube. The nurse should clarify which of the following prescriptions with the provider? - Vigorously strip the chest tube twice daily 36.A nurse is teaching a client who is taking an ACE inhibitor for heart failure. Which of the following instructions should the nurse include for home management of heart failure? - Monitor Intake and Output 37.A nurse is providing discharge teaching to a client who has a permanent pacemaker. Which of the following statements by the client indicates an understanding of the teaching? - I need to check my pulse rate every day for a full minute. 38.A nurse in a clinic is providing preventive teaching to an older adult client during well visit. The nurse should instruct the client that which of the following immunization are recommended for healthy adults after age 60? Herpes Zoster Influenza Pneumococcal Polysaccharide 39.A nurse is assessing a client who is 4hr postoperative following arterial revascularization of the left femoral artery. Which of the following findings should the nurse report immediately? - Pallor in the affected extremity 40.A nurse is caring for an older adult client who has not been eating. Which of the following findings indicates dehydration? - Diminished peripheral pulses 41.A nurse is preparing to discharge a client who has a halo device and is reviewing new prescriptions from the provider. The nurse should clarify which of the following prescriptions with the provider? - May operate a motor vehicle when no longer taking analgesics 42.A nurse is assessing for elderly signs of compartment syndrome for a client who has a short leg fiberglass cast. Which of the following findings should the nurse expect? - Intense pain with movement 43.A nurse is caring for a client who is postoperative following coronary artery bypass surgery and reports shortness of breath. The nurse administers oxygen at 3L/min and obtains arterial blood gases 60 min later. Which of the following lab findings indicates a positive response to the oxygen therapy? - PaO2 90 mmHg 44.A nurse is performing a cranial nerve assessment on a client following a head injury. Which of the following findings should the nurse expect if the client has impaired function of the vestibulocochlear (VIII)? - Disequilibrium with movement 45.A nurse is caring for a client admitted with a skull fracture. Which of the following assessment findings should be of greatest concern to the nurse? - Glasgow coma scale score changes from 14 to 9 46.A nurse is caring for a client who is taking furosemide. The client has a potassium level of 3.1 mEq/L. Which of the following should the nurse assess first? - Cardiovascular status dysrhythmia due to potassium 47.A nurse is caring for a client who is scheduled for an abdominal paracentesis. The nurse should plan to take which of the following actions? - Ask the client to empty his bladder prior to the procedure 48.A nurse is caring for a client who is 6 hours postoperatively following a thyroidectomy. The client reports tingling and numbness in the hands. The nurse should identify this as a sign of which of following electrolytes imbalances? - Hypocalcemia 49.A nurse is assessing a client 15 min after the start of a transfusion of 1 unit of packed RBC's. Which of the following findings is an indication of a hemolytic transfusion reaction? - Hypotension 50.A nurse in an emergency department is caring for a client who has sinus bradycardia. Which of the following actions should the nurse take first? - Administer atropine to the client 51.A nurse is caring for a client who has a prescription to discontinue a peripherally inserted central catheter. Which of the following actions should the nurse take? - Place a dry sterile dressing to the site after removal 52.A nurse is caring for a client who has a flail chest. Which of the following actions should the nurse take? - Provide humidified oxygen 53.A nurse is teaching a group of newly licensed nurses about acute respiratory failure. Which of the following manifestations should the nurse include in the teaching? - Hypoxemia 54.A nurse is caring for a client who is experiencing a seizure. Which of the following actions should the nurse take? - Lower the client to the floor (ATI video says this if standing) 55.A nurse is teaching a client who is receiving total parenteral nutrition at home through a central venous access device about transparent dressing changes. Which of the following instructions should the nurse include in the teaching? - Wear a mask during dressing change 56.A nurse is caring for a client in the emergency department who experienced a full-thickness burn injury to the lower torso 1 hr. ago. Which of the following findings should the nurse expect? - Hypotension 57.A nurse in an emergency department is assessing a client who has cirrhosis of the liver. Which of the following is a priority finding? - Mental confusion 58.A nurse is providing instructions about foot care for a client who has a peripheral arterial disease. The nurse should identify which of the following statements by the client indicates an understanding of the teaching? - I rest in my recliner with my feet elevated for about an hour every afternoon 59.A nurse is teaching a client who has a new prescription for alendronate to treat osteoporosis. Which of the following instructions should the nurse include in the teaching? - Sit upright for 30 min after taking the medication 60.A nurse is admitting a client to the emergency department after a gunshot wound to the abdomen. Which of the following actions should the nurse take to help prevent the onset of acute kidney failure? - Administer IV fluids to the client 61.A nurse is completing an assessment of an older adult client and notes redness areas over the bony prominences, but the client's skin is intact. Which of the following interventions should the nurse include in the plan of care? - Support bony prominences with pillows 62.A nurse is caring for a client who has completed 10 daily cycles of Total Parenteral Nutrition (TPN). Which of the following findings indicates that the client is receiving adequate TPN supplementation - Weight gain of 9.1 kilograms to 20 pounds