A.T.I Med-Surg
Version-1
,2) Oral temperature of 37.5° C (99.5° F)
3) Thick, red-colored urine
4) Pain level of 4 on a 0 to 10 rating scale
A nurse is caring for a client who has a temperature of 39.7° C (103.5° F) and has a prescription
for a hypothermia blanket. The nurse should monitor the client for which of the following
adverse effects of the hypothermia blanket?
1) Shivering
2) Infection
3) Burns
4) Hypervolemia
A nurse is reinforcing teaching about exercise with a client who has type 1 diabetes mellitus.
Which of the following statements by the client indicates an understanding of the teaching?
1) "I will carry a complex carbohydrate snack with me when I exercise."
2) "I should exercise first thing in the morning before eating breakfast."
3) "I should avoid injecting insulin into my thigh if I am going to go running."
4) "I will not exercise if my urine is positive for ketones."
A nurse notes a small section of bowel protruding from the abdominal incision of a client who is
postoperative. After calling for assistance, which of the following actions should the nurse take
first?
1) Cover the client's wound with a moist, sterile dressing.
2) Have the client lie supine with knees flexed.
3) Check the client's vital signs.
,4) Inform the client about the need to return to surgery.
A nurse is collecting data from a client who has alcohol use disorder and is experiencing
metabolic acidosis. Which of the following manifestations should the nurse expect?
1) Cool, clammy skin.
2) Hyperventilation
3) Increased blood pressure
4) Bradycardia
A nurse is reinforcing discharge teaching with a client following a cataract extraction. Which of
the following should the nurse include in the teaching?
1) Avoid bending at the waist.
2) Remove the eye shield at bedtime.
3) Limit the use of laxatives if constipated.
4) Seeing flashes of light is an expected finding following extraction.
A nurse is caring for a client who has heart failure and has been taking digoxin 0.25 mg daily.
The client refuses breakfast and reports nausea. Which of the following actions should the nurse
take first?
1) Suggest that the client rests before eating the meal.
2) Request a dietary consult.
3) Check the client's vital signs.
4) Request an order for an antiemetic.
A nurse is caring for a client who is 3 days postoperative following a cholecystectomy. The
nurse suspects the client's wound is infected because the drainage from the dressing is yellow
and thick. Which of the following findings should the nurse report as the type of drainage found?
, 1) Sanguineous
2) Serous
3) Serosanguineous
4) Purulent
A nurse is reinforcing discharge teaching to a client following arthroscopic surgery. To prevent
postoperative complications which of the following actions should be reinforced during the
teaching?
1) Administer an opioid analgesic to the client 30 min prior to initiating CPM exercises.
2) Place the client’s affected leg into the CPM machine with the machine in the flexed
position.
3) Place the client into a high Fowler’s position when initiating the CPM exercises.
4) Align the joints of the CPM machine with the knee gatch in the client’s bed.
A nurse is collecting data from a client who has emphysema. Which of the following findings
should the nurse expect? (Select all that apply.)
1) Dyspnea
2) Barrel chest
3) Clubbing of the fingers
4) Shallow respirations
5) Bradycardia
A nurse is caring for a client who sustained a basal skull fracture. When performing morning
hygiene care, the nurse notices a thin stream of clear drainage coming from out of the client's
right nostril. Which of the following actions should the nurse take first?
Version-1
,2) Oral temperature of 37.5° C (99.5° F)
3) Thick, red-colored urine
4) Pain level of 4 on a 0 to 10 rating scale
A nurse is caring for a client who has a temperature of 39.7° C (103.5° F) and has a prescription
for a hypothermia blanket. The nurse should monitor the client for which of the following
adverse effects of the hypothermia blanket?
1) Shivering
2) Infection
3) Burns
4) Hypervolemia
A nurse is reinforcing teaching about exercise with a client who has type 1 diabetes mellitus.
Which of the following statements by the client indicates an understanding of the teaching?
1) "I will carry a complex carbohydrate snack with me when I exercise."
2) "I should exercise first thing in the morning before eating breakfast."
3) "I should avoid injecting insulin into my thigh if I am going to go running."
4) "I will not exercise if my urine is positive for ketones."
A nurse notes a small section of bowel protruding from the abdominal incision of a client who is
postoperative. After calling for assistance, which of the following actions should the nurse take
first?
1) Cover the client's wound with a moist, sterile dressing.
2) Have the client lie supine with knees flexed.
3) Check the client's vital signs.
,4) Inform the client about the need to return to surgery.
A nurse is collecting data from a client who has alcohol use disorder and is experiencing
metabolic acidosis. Which of the following manifestations should the nurse expect?
1) Cool, clammy skin.
2) Hyperventilation
3) Increased blood pressure
4) Bradycardia
A nurse is reinforcing discharge teaching with a client following a cataract extraction. Which of
the following should the nurse include in the teaching?
1) Avoid bending at the waist.
2) Remove the eye shield at bedtime.
3) Limit the use of laxatives if constipated.
4) Seeing flashes of light is an expected finding following extraction.
A nurse is caring for a client who has heart failure and has been taking digoxin 0.25 mg daily.
The client refuses breakfast and reports nausea. Which of the following actions should the nurse
take first?
1) Suggest that the client rests before eating the meal.
2) Request a dietary consult.
3) Check the client's vital signs.
4) Request an order for an antiemetic.
A nurse is caring for a client who is 3 days postoperative following a cholecystectomy. The
nurse suspects the client's wound is infected because the drainage from the dressing is yellow
and thick. Which of the following findings should the nurse report as the type of drainage found?
, 1) Sanguineous
2) Serous
3) Serosanguineous
4) Purulent
A nurse is reinforcing discharge teaching to a client following arthroscopic surgery. To prevent
postoperative complications which of the following actions should be reinforced during the
teaching?
1) Administer an opioid analgesic to the client 30 min prior to initiating CPM exercises.
2) Place the client’s affected leg into the CPM machine with the machine in the flexed
position.
3) Place the client into a high Fowler’s position when initiating the CPM exercises.
4) Align the joints of the CPM machine with the knee gatch in the client’s bed.
A nurse is collecting data from a client who has emphysema. Which of the following findings
should the nurse expect? (Select all that apply.)
1) Dyspnea
2) Barrel chest
3) Clubbing of the fingers
4) Shallow respirations
5) Bradycardia
A nurse is caring for a client who sustained a basal skull fracture. When performing morning
hygiene care, the nurse notices a thin stream of clear drainage coming from out of the client's
right nostril. Which of the following actions should the nurse take first?
