NGN ATI RN MEDICAL SURGICAL 2023
PROCTORED EXAM/NGN ATI RN MED SURG 2023
PROCTORED EXAM 90 QUESTIONS WITH
DETAILED VERIFIED ANSWERS AND RATIONALE
... [Show More]
/A+ GRADE ASSURED
A nurse is assessing a client while suctioning the
client's tracheostomy tube. Which of the following
findings should indicate to the nurse the client is
experiencing hypoxia?
- The client starts to cough
- The client's heart rate increases
- The client is diaphoretic
- The client's blood pressure decreases -
...ANSWER...- The client's heart rate increases
RATIONALE: Hypoxia related to suctioning can cause
the client's heart rate to increase. If this occurs, the
nurse should discontinue the suctioning and manually
oxygenate the client with 100% oxygen. The nurse
should instruct the client to take 3 or 4 deep breaths
prior to suctioning to reduce the risk for hypoxia.
A nurse is providing follow-up care for a client who
sustained a compound fracture 3 weeks ago. The
nurse should recognize that an expected finding for
which of the following laboratory values is a
manifestation of osteomyelitis and should be reported
to the provider?
- Sedimentation rate
- Hematocrit
- Calcium
- Acid phosphatase - ...ANSWER...- Sedimentation rate
RATIONALE: An increased sedimentation rate occurs
when a client has any type of inflammatory process,
such as osteomyelitis.
A nurse is providing instructions to a client who has
type 2 diabetes mellitus and a new prescription for
metformin. Which of the following statements by the
client indicates an understanding of the teaching?
- "I will monitor my blood sugar carefully because the
medication increases the secretion of insulin."
- "I should take this medication with a meal."
- "I can expect to gain weight while taking this
medication."
- "While taking this medication, I will experience
flushing of my skin." - ...ANSWER...- "I should take this
medication with a meal."
RATIONALE: The client should take metformin with or
immediately following meals to improve absorption
and to minimize GI distress.
A nurse is performing a dressing change for a client
who is recovering from a hemicolectomy. When
removing the dressing, the nurse notes that a large
part of the bowel is protruding through the abdomen.
Which of the following actions should the nurse take
first?
- Place the client in a supine position
- Measure vital signs
- Cover the wound with a sterile, saline-moistened
dressing
- Call for help - ...ANSWER...- Call for help
RATIONALE: Evidence-based practice indicates that
the nurse should first stay with the client and call for
assistance. The client will require emergency surgery
and is at risk for shock. Therefore, the nurse should
obtain immediate assistance.
A nurse is caring for a client who is experiencing a
tonic-clonic seizure. Which of the following actions
should the nurse take?
- Insert a padded tongue blade
- Apply oxygen
- Restrain the client
- Loosen restrictive clothing - ...ANSWER...- Loosen
restrictive clothing
RATIONALE: The nurse should loosen tight, restrictive
clothing to prevent injury and suffocation.
A nurse is assessing a group of clients for indications
of role changes. The nurses should identify that which
of the following clients is at risk for experiencing a
role change?
- A client who has type 1 diabetes mellitus and is
starting to self-monitor blood glucose
- A client who had a cholecystectomy and is starting
on a modified-fat diet
- A client who has Crohn's disease and is
experiencing diarrhea 3 times a day
- A client who has multiple sclerosis and is
experiencing progressive difficulty ambulating -
...ANSWER...- A client who has multiple sclerosis and
is experiencing progressive difficulty ambulating
RATIONALE: The nurse should identify that
progression of a neurologic disease such as multiple
sclerosis can lead to a role change as the client
becomes less independent.
A nurse is caring for a client 1 hr following a cardiac
catheterization. The nurse notes the formation of a
hematoma at the insertion site and a decreased pulse
rate in the affected extremity. Which of the following
interventions is the nurse's priority?
- Initiate oxygen at 2 L/min via nasal cannula
- Apply firm pressure to the insertion site
- Take the client's vital signs
- Obtain a stat order for an aPTT - ...ANSWER...- Apply
firm pressure to the insertion site
RATIONALE: The greatest risk to the client is bleeding.
Therefore, the priority intervention is for ythe nurse to
apply firm pressure to the hematoma and stop the
bleeding.
A nurse is caring for a client who has amyotrophic
lateral sclerosis (ALS) and is being admitted to the
hospital with pneumonia. Which of the following
assessment findings is the nurse's priority?
- Temperature 38.4 (101.1 F)
- Increased respiratory secretions
- Fluid intake of 200 mL in the prior 8 hr
- Limited ROM - ...ANSWER...- Increased respiratory
secretions
RATIONALE: Using the airway, breathing, circulation
approach to client care, the nurse should determine
that the priority assessment finding is increased
respiratory secretions. Clients who have ALD may
experience respiratory muscle weakness and
dysphagia, and excessive respiratory secretions can
impair the ability to clear the airway, which increases
the client's risk for aspiration.
A nurse is caring for a client who had a nephrostomy
tube inserted 12 hr ago. Which of the following findings
indicates a potential complication?
- The client's urinary output has increased
- The client reports back pain
- The client's urine is red tinged
- The client's tube requires irrigation - ...ANSWER...-
The client reports back pain [Show Less]