ATI RN MEDICAL SURGICAL PROCTORED EXAMS WITH 25 LATEST MULTIPLE VERSIONS EXAMS UPDATED 2023 GRADE A+
Medical Surgical ATI
Lyme Disease
A nurse is pro... [Show More] viding teaching to a client who has a severe form of stage II Lyme disease. Understanding of the patient teaching. ANS: My joints ache because I have Lyme disease. Chronic complications memory problem and fatigue
Musculoskeletal: Osteoporosis/Osteomyelitis
A nurse is assessing for compartment syndrome in a client who has a short leg cast. Which of the following findings is a manifestation of this condition? ANS: Pain that increases with passive movement. Other s/s diminished pulse or pulselessness and capillary refill greater than 2 seconds in the affected extremity. Warmth indicates infection.
A nurse is providing postoperative teaching for a client who had a total knee arthroplasty. Which of the following instructions should the nurse include? Flex the foot every hour when awake. Avoid placing pillows under the knee. Elevate the leg when sitting in a chair to reduce edema and pain. Keep the operative leg in a neutral position when resting in bed
Teaching external fixation device for fracture of lower extremity: use crutches with rubber tip. Casts/splints/boots applied. Continuous use for 4-6 weeks. Teach wound and pin care. Only provider can adjust.
Post-op open reduction internal fixation of the ankle. What assessment report: extremity cool on palpation. Other findings to report: pallor, cool temp, paresthesia
A nurse is assessing a client who has a diagnosis of rheumatoid arthritis. Which of the following nonpharmacological interventions should the nurse suggest to the client to reduce pain? Alternate application of heat and cold to the affected joints. Diet high in nutrients, such as protein, vitamins, and iron, to promote tissue repair. Elevation of the affected extremities does not relieve the painful inflammation caused by rheumatoid arthritis.
Elevation of the extremities can assist with managing the pain of a client who has peripheral vascular disease. Regular exercise is important to prevent stiffness.
Caring for a client with hx of a compound fracture, 3 wks ago. Unexpected finding showing osteomyelitis? ANS: Sedimentation rate. An increased sedimentation rate occurs when a client has any type of inflammatory process, such as osteomyelitis.
A nurse is teaching a client about osteoporosis prevention. The nurse should instruct the client which of the following medications can increase their risk of developing osteoporosis? ANS: Prednisone. The nurse should instruct the client that prednisone can increase the risk for developing osteoporosis due to suppression of bone formation, and an increase in bone resorption by osteoclasts. Prednisone can also reduce intestinal absorption of calcium. Conjugated estrogen reduces risk.
Colchicine can cause aplastic anemia.
A nurse is providing education to a client who is at risk for osteoporosis. Which of the following instructions should the nurse include? Walk for 30 mins four times per week. Other teaching: Glucosamine for pain, avoid exercises that cause jarring motions, such as jogging, take over-the-counter calcium supplements.
Procedures
Suctioning client tracheostomy tube. Signs of hypoxia: The client’s heart rate increases. Coughing is expected. Late signs are diaphoresis and a decrease in blood pressure and will not be seen now. An increase in blood pressure is an early sign.
A nurse is caring for a client who has an arterial line. Nursing action to take? ANS: Place a pressure bag around the flush solution. Arterial line used for ABG samples and hemodynamic monitoring. Supine, HOB 60 degrees.
A nurse is assessing a client following the completion of hemodialysis. Which of the following findings is the nurse's priority to report to the provider? Restlessness. Expected: inc temp, dec BP, weight loss.
A nurse is providing teaching to a client who has end-stage kidney disease and is waiting for a kidney transplant. Which of the following information should the nurse provide? Hemodialysis is sometimes required following surgery. Transplant can come from a living or deceased donor. Lifelong immunosuppressive therapy is necessary for the organ recipient. Following transplant, clients should follow dietary restrictions to prevent rejection.
A nurse is caring for a client who had a nephrostomy tube inserted 12hrs ago. Report to the doc? ANS: The client complains of back pain. This indicates the tube may have clogged or is dislodged. Report decrease in UO. Red tinged urine expected post 12-24hrs
Planning care for a client who is scheduled for a thoracentesis. Nursing interventions. ANS: Encourage the client to take deep breaths after the procedure. Other: upright position, arm resting overhead table, local anesthetic, npo not needed. Resumes activity within 1 hr post procedure.
A PACU nurse is assessing a client who is postoperative following a right nephrectomy. The client's inital vital signs were HR 80, BP 130/70, R 16, and temp 96.8. Which of the following vital sign changes should alert the nurse that the client might be hemorrhaging? HR 110. one of the first signs of hemorrhage is an increase in the heart rate from the client's baseline, which occurs to compensate for blood loss. An early sign of hemorrhage is a slight increase in the diastolic blood pressure. As bleeding progresses, the systolic blood pressure will decrease. An increase in blood pressure postoperatively can indicate that the client is in pain. An increase in the respiratory rate from the client’s baseline is an indication of hemorrhage. An increase in temperature from the client’s baseline is an indication of infection, not hemorrhage.
A nurse is caring for a client following extubation of an endotracheal tube 10 mins ago. Priority to report? ANS: Stridor. Expected findings: hoarseness, sore throat, oral secretions
TURP post opp, clots in indwelling catheter: irrigate the catheter. Traction applied to reduce risk of bleeding.
A nurse is planning for a client who is postoperative following a laparotomy and has a closed-suction drain. Which of the following actions should the nurse take to manage the drain? ANS: Compress the drain reservoir after emptying
Compressing the reservoir creates a vacuum that draws fluid out of the wound, through the drain, and into the reservoir. A closed-suction drain uses a reservoir for collecting drainage and applies negative pressure, which allows the drainage to collect in the reservoir rather than relying on gravity, and does not require wall suction. A Penrose drain allows drainage to collect on a sterile gauze dressing.
A nurse is teaching a client about the use of transcutaneous electrical nerve stimulation (TENS) for the management of bone cancer pain. The nurse should explain that applying a TENS unit to the painful area has which of the following effects? A tingling sensation replacing the pain. A TENS unit applies small electric currents to the painful area, with the client increasing the current until the “pins and needles” sensation overrides the pain.
Elimination
8 hr post opp total hip arthroplasty. Unable to void in a bedpan. Action take first: Scan the bladder with a portable ultrasound.
TB
Discharge teaching active TB (Tuberculosis): Sputum specimens q 2-4 w until there are three negative cultures. Client no longer contagious post 2-3 weeks of initiation of TB medications. Family members take no precautions because
they have already been exposed. Follow up evaluation chest X-Ray, not skin test.
TB patient and family education: Family members in the household should undergo TB testing. Other teaching: cover mouth when cough/sneeze and suppose tissues in plastic bag. Wear mask in public.
TB precautions: Airborne. Other diseases that need airborne: measles, varicella, disseminated varicella zoster. Droplet: flu, rubella, pneumonia, streptococcal pharyngitis, pertussis, mumps. Contact: MRSA, VRE, respiratory syncytial virus, scabies, c-diff. Protective: immunocompromised.
Medications
Inc ICP. Receive Mannitol. Adverse Effect: Other adverse effects: tachycardia, edema, dyspnea, decreased O2 sat. Therapeutic effect: increased urinary output.
Teaching for psyllium (bulk forming laxative). 240 ml or 8 oz of water drink post administration. Works in 12-24 hrs, expect BM regularity in 2-3 days.
Take it post meals. Increase dietary fiber to help constipation.
Warfarin for Afib, desired outcome: INR 2.5 (2-3 target range). Heparin
aPTT 45-90
A nurse is obtaining a medication history from a client who is scheduled to undergo cataract surgery. The nurse should recognize that which of the following client medications is a contradiction for the surgery and notify the provider? Warfarin. Warfarin increases the client's risk for bleeding, and is contraindicated for a client scheduled for eye or central nervous system surgery.
Osteomyelitis gentamicin prescription withhold: serum creatinine (nephrotoxic). High temp, BP, and WBC expected.
A nurse is providing discharge teaching to a client who is to self administer heparin subcut. Understanding of the teaching? ANS: I will use an electric razor to shave. Heparin is an anticoagulant that places the client at the risk for bleeding. Therefore, the nurse should instruct the client to use an electric razor when shaving to reduce the risk of cuts to the skin, avoid flossing, apply firm pressure to the injection site for 1 to 2 min but to avoid massaging it.
A nurse is providing teaching to a client who is premenopausal and is on hormone replacement therapy. Adverse effects. ANS: Calf pain, numbness in arms, intense headache. Night sweats and vaginal dryness are expected findings of menopause.
A nurse is reviewing the laboratory results of a client who has AIDS and is taking amphotericin B for a fungal infection. The nurse should identify that which of the following values is an indication of an adverse effect of the medication? BUN 34 mg/dL. Amphotericin B can cause damage to the kidneys and can cause several metabolic imbalances, including hyponatremia, hypokalemia, and hypomagnesemia. It can also cause bone marrow suppression and, as a result, a decreased hematocrit. Amphotericin B is nephrotoxic. Therefore, an elevated BUN or creatinine level can indicate renal impairment. The nurse should notify the provider of this result.
A nurse is providing teaching to a client who has hypertension and a new prescription for verapamil. Which of the following information should the nurse include in the teaching? "Increase fiber intake to avoid constipation" Verapamil with meals or milk to decrease gastric irritability. Eczema can develop 3 to 6 months after the beginning of verapamil therapy. constipation is an adverse effect of verapamil. Monitor blood pressure weekly and report manifestations of hypotension to the provider.
Mastectomy
Post opp modified radical mastectomy: numbness can occur along the inside of the affected arm. Other teaching: stand upright and avoid flexing
the affected arm when ambulating. Active ROM 1 week post opp. Wear loose fitting clothing.
A nurse is providing pre-op teaching for a client who is scheduled for a mastectomy. Statements the nurse should make? ANS: I will refer you to community resources for support
A nurse is planning care for a client who is having a modified radical mastectomy of the right breast. Which of the following interventions should the nurse include in the plan of care? Instruct the client that the drain will be removed when there is 25 mL of output or less over a 24 hr period. Remains in place - 1-3 weeks post surgery. Exercise 24 h post. Elevate affected arm on pillow. HOB 30 degree.
Infection
A nurse is caring for a client who has a positive culture for methicillin- resistant Staphylococcus aureus (MRSA). Which of the following actions should the nurse take? Bathe the client using chlorhexidine solution. Nasal specimen for colonization. Visitors gown and gloves. [Show Less]
