ATI RN ADULT MEDICAL SURGICAL
PROCTORED RETAKE EXAM 2019
WITH VERIFIED SOLUTIONS/A+
GRADE
1. A nurse is assessing for early signs of compartment
... [Show More] syndrome for a client who has a
short-leg fiberglass cast. Which of the following findings should the nurse expect?
a. Capillary refill less than 2 seconds
b. Intense pain with movement
c. Bounding distal pulses
d. Erythema of the toes
2. A nurse is monitoring a client who is receiving 2 units of packed RBC’s. Which of the
following manifestations indicates a hemolytic transfusion reaction?
a. Bradycardia
b. Hypertension
c. Back pain
d. Chills
3. A nurse is caring for a client who had a total hip arthroplasty. Which of the following
actions should the nurse take to prevent hip dislocation?
a. Remove the wedge device when turning
b. Elevate the knees higher than the hips when sitting
c. Encourage the client to lean forward when attempting to stand
d. Place two bed pillows between the legs when in bed
4. A nurse is assessing a client who is perioperative and reports an allergy to bananas. The
nurse should recognize that the client is at risk for an allergic cross-reactivity to which of
the following substances?
a. Povione-Iodine b. Latex
c. Anesthetics
d. Adhesive tape
● .
5. A nurse is teaching a client about the use of an incentive spirometer. Which of the
following instructions should the nurse include in the teaching?
a. Hold breaths about 3 to 5 seconds before exhaling
b. Position the mouthpiece 2.5cm (1 in.) from the mouth
c. Exhale slowly through pursed lips
d. Place hands on the upper abdomen during inhalation
.
6. A nurse is caring for a client who arrives at the emergency department and reports
vomiting and diarrhea for the past 3 days. The client’s serum potassium level is 2.8
extension, and hand-wall climbing) to prevent
mEq/L. Which of the following interventions should the nurse implement first?
a. Check the client’s hand grasps
b. Initiate cardiac monitoring for the client
c. Listen to the client’s bowel sounds
d. Administer an IV potassium drip
7. A nurse is preparing to administer peritoneal dialysis to a client. Which of the following
actions should the nurse take?
a. Hang the drainage bag below the client’s abdomen
b. Use clean technique to access the catheter
c. Chill the dialysate before administration
d. Place the client in high-fowlers position
8. 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 nerve (cranial nerve VIII)?
a. Loss of peripheral vision
b. Inability to smell
c. Deviation of the tongue from midline
d. Disequilibrium with movement
9. A nurse is planning care for a client who is 1 day postoperative following an open
cholecystectomy. Which of the following interventions should the nurse include in the
plan of care?
a. P [Show Less]