Ati Med-Surg Proctored Exam B 2019
1. A Nurse is contributing to the plan care of a care to promote a restful night’s sleep for a client who
has Alzheimer’s disease. Which of the following interventions should the nurse include in the plan?
Encourage stimulating activities after
dinner Encourage a late afternoon nap
Offer a small snack at bedtime
Offer hot chocolate at
bedtime
2. A nurse if reinforcing teaching with a client who has chronic kidney disease about disease management.
Which of the following statements by the client indicates an understanding of the teaching?
I will add a banana to my morning cereal
I will decrease my intake of
carbohydrates I will limit my daily intake
of protein
I will season my food with a salt substitute
3. A nurse is caring for a client who has just returned to the unit following a bronchoscopy. Which of the
following findings should the nurse report to the provider?
Absent gag reflex
Blood tinged mucus
Diminished breath sounds
Oxygen saturation 95%
4. A nurse is caring for a client who begins to have a seizure while ambulating in the hall. Identify the sequence of
actions the nurse should follow. (Move the steps the nurse should take into the box on the right placing them
in order of performance. Use all the steps.
Lower the client to the floor
Place a pad beneath the client’s head
Loose the clothing around the client’s
neck Time the length of the client’s
seizure Reorient and reassure the client
5. A nurse is reinforcing teaching with a client who has a new diagnosis of genital herpers. Which of the
following information should the nurse include in the teaching?
Use condoms when lesions are present
Look for lesions that have a wart-like appearance
The virus can be transmitted without lesions
present
The lesion resolves in 2 weeks and usually do not recur
,6. A nurse is planning care for a group of clients after receiving change-of-shift report. Which of the
following clients should the nurse plan to see first?
A client who had a colectomy 2 days ago and has a nasogastric tube Jackson-Pratt drain and indwelling urinary
catheter.
A client who is dehydrated has mental confusion and was found getting out of bed several times during the
night.
A client who had a right lower lobe lobectomy 4 days ago and has a chest tube set to continuous suction.
A client who has pneumonia and an oral temperature of 38.7°C (101.7°F)
7. A nurse is caring for a client who is receiving a continuous tube feeding of 60 mL/hr at 1.2 cal/mL. How
many calories will the client receive in 12 hrs? (Round the answer to the nearest whole number)
Step 1: What is the unit of measurement the nurse should calculate? Calories
Step 2: What is the volume the nurse should infuse? 60 mL/hr x 12 hr = 720 mL
Step 3: What is the total infusion time? 12 hrs
Step 4: Should the nurse convert the units of measurement? No
Step 5: Set up an equation and solve for
x. 720 mL x 1.2 cal/mL = calories
x = 864 cal
8. A nurse is caring for a client who is in Buck's traction for a fractured hip. The client reports increased pain at
the site of the fracture. Which of the following actions should the nurse take?
Massage the area
Remove the weights
Loosen the ropes
Reposition the client
9. A nurse is reinforcing teaching with a client who is taking levothyroxine. Which of the following statements
by the client indicates an understanding of the teaching?
I will need to take the medication until my thyroid function returns to normal
The medication should be taken before I eat breakfast every morning
The medication might lower my blood sugar
I will take the medication with an antacid if it gives me heartburn
10. A nurse is delegating the task of repositioning a client who is in skeletal traction to an assistive personnel
(AP). Which of the following instructions should the nurse give the AP?
Allow the weights to hang
freely Release the tension of
the ropes
Remove the weights when rewrapping bandages
Manually lift the weights when moving the client up in bed
, 11. A nurse is reinforcing teaching about pursed-lip breathing with a client who has a new diagnosis of COPD.
The nurse should identify which of the following client statements indicates an understanding of the
teaching?
I should perform pursed-lip breathing exercises before going to
be When I’m fatigued, I should inhale slowly through pursed-lips
Pursed-lip breathing works best for activities like walking up
stairs
I will exhale through my nose after breathing in through pursed-lips
12. A nurse is admitting a client who is suspected of having active tuberculosis (TB). Which of the following
actions should the nurse take first?
Administer anti-tuberculosis medication
Institute airborne precautions
Obtain sputum cultures
Auscultate breath
sounds
13. A nurse is preparing a client for a cardiac catheterization. Which of the following actions should the nurse
take first?
Verify the client has given informed
consent Administer preoperative
medication
Make the location of the pedal
pulses Have the client void
14. A nurse is assisting in the plan of care for a client who had a recent left hemispheric stroke. Which of
the following actions should the nurse include in the plan?
Observe for impulsive behavior
Approach the client from the right
side
Use simple verbal cues when directing tasks
Place the client in low-fowler’s position during meals
15. A nurse is assisting with an educational program for clients who have been newly diagnosed with
diabetes mellitus. Which of the following instructions should the nurse include in the program regarding
insulin?
Store unopened insulin vials in the freezer for up to 1 month
Opened insulin can be stored on a cool countertop away from light
Roll discolored insulin gently to mix before use
Use refrigerated insulin immediately after removing it from the refrigerator
16. A nurse is caring for a client who reports shortness of breath and has an oxygen saturation of 90%. Which of
the following actions should the nurse take?
Prepare for intubation of the client
Administer opioid medication
1. A Nurse is contributing to the plan care of a care to promote a restful night’s sleep for a client who
has Alzheimer’s disease. Which of the following interventions should the nurse include in the plan?
Encourage stimulating activities after
dinner Encourage a late afternoon nap
Offer a small snack at bedtime
Offer hot chocolate at
bedtime
2. A nurse if reinforcing teaching with a client who has chronic kidney disease about disease management.
Which of the following statements by the client indicates an understanding of the teaching?
I will add a banana to my morning cereal
I will decrease my intake of
carbohydrates I will limit my daily intake
of protein
I will season my food with a salt substitute
3. A nurse is caring for a client who has just returned to the unit following a bronchoscopy. Which of the
following findings should the nurse report to the provider?
Absent gag reflex
Blood tinged mucus
Diminished breath sounds
Oxygen saturation 95%
4. A nurse is caring for a client who begins to have a seizure while ambulating in the hall. Identify the sequence of
actions the nurse should follow. (Move the steps the nurse should take into the box on the right placing them
in order of performance. Use all the steps.
Lower the client to the floor
Place a pad beneath the client’s head
Loose the clothing around the client’s
neck Time the length of the client’s
seizure Reorient and reassure the client
5. A nurse is reinforcing teaching with a client who has a new diagnosis of genital herpers. Which of the
following information should the nurse include in the teaching?
Use condoms when lesions are present
Look for lesions that have a wart-like appearance
The virus can be transmitted without lesions
present
The lesion resolves in 2 weeks and usually do not recur
,6. A nurse is planning care for a group of clients after receiving change-of-shift report. Which of the
following clients should the nurse plan to see first?
A client who had a colectomy 2 days ago and has a nasogastric tube Jackson-Pratt drain and indwelling urinary
catheter.
A client who is dehydrated has mental confusion and was found getting out of bed several times during the
night.
A client who had a right lower lobe lobectomy 4 days ago and has a chest tube set to continuous suction.
A client who has pneumonia and an oral temperature of 38.7°C (101.7°F)
7. A nurse is caring for a client who is receiving a continuous tube feeding of 60 mL/hr at 1.2 cal/mL. How
many calories will the client receive in 12 hrs? (Round the answer to the nearest whole number)
Step 1: What is the unit of measurement the nurse should calculate? Calories
Step 2: What is the volume the nurse should infuse? 60 mL/hr x 12 hr = 720 mL
Step 3: What is the total infusion time? 12 hrs
Step 4: Should the nurse convert the units of measurement? No
Step 5: Set up an equation and solve for
x. 720 mL x 1.2 cal/mL = calories
x = 864 cal
8. A nurse is caring for a client who is in Buck's traction for a fractured hip. The client reports increased pain at
the site of the fracture. Which of the following actions should the nurse take?
Massage the area
Remove the weights
Loosen the ropes
Reposition the client
9. A nurse is reinforcing teaching with a client who is taking levothyroxine. Which of the following statements
by the client indicates an understanding of the teaching?
I will need to take the medication until my thyroid function returns to normal
The medication should be taken before I eat breakfast every morning
The medication might lower my blood sugar
I will take the medication with an antacid if it gives me heartburn
10. A nurse is delegating the task of repositioning a client who is in skeletal traction to an assistive personnel
(AP). Which of the following instructions should the nurse give the AP?
Allow the weights to hang
freely Release the tension of
the ropes
Remove the weights when rewrapping bandages
Manually lift the weights when moving the client up in bed
, 11. A nurse is reinforcing teaching about pursed-lip breathing with a client who has a new diagnosis of COPD.
The nurse should identify which of the following client statements indicates an understanding of the
teaching?
I should perform pursed-lip breathing exercises before going to
be When I’m fatigued, I should inhale slowly through pursed-lips
Pursed-lip breathing works best for activities like walking up
stairs
I will exhale through my nose after breathing in through pursed-lips
12. A nurse is admitting a client who is suspected of having active tuberculosis (TB). Which of the following
actions should the nurse take first?
Administer anti-tuberculosis medication
Institute airborne precautions
Obtain sputum cultures
Auscultate breath
sounds
13. A nurse is preparing a client for a cardiac catheterization. Which of the following actions should the nurse
take first?
Verify the client has given informed
consent Administer preoperative
medication
Make the location of the pedal
pulses Have the client void
14. A nurse is assisting in the plan of care for a client who had a recent left hemispheric stroke. Which of
the following actions should the nurse include in the plan?
Observe for impulsive behavior
Approach the client from the right
side
Use simple verbal cues when directing tasks
Place the client in low-fowler’s position during meals
15. A nurse is assisting with an educational program for clients who have been newly diagnosed with
diabetes mellitus. Which of the following instructions should the nurse include in the program regarding
insulin?
Store unopened insulin vials in the freezer for up to 1 month
Opened insulin can be stored on a cool countertop away from light
Roll discolored insulin gently to mix before use
Use refrigerated insulin immediately after removing it from the refrigerator
16. A nurse is caring for a client who reports shortness of breath and has an oxygen saturation of 90%. Which of
the following actions should the nurse take?
Prepare for intubation of the client
Administer opioid medication
