ATI PROCTORED EXAM MEDICAL SURGICAL FORM A 2019
ATI Proctored Exam Medical Surgical Form A
1. A nurse is preparing to administer thrombolytic therapy to a client who had an ischemic
stroke. Which of the following is an appropriate nursing action?
-Start the therapy within 8 hrs. (within 6 hrs.)
-Insert an indwelling urinary catheter after therapy begins
-Monitor blood pressure every 30 minutes during infusion.
-Elevate the head of the bed between 25 and 30 degrees (to reduce ICP & promote venous
drainage, ATI page 89)
2. 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?
-Place hands on the upper abdomen during inhalation.
-Exhale slowly through pursed lips.
-Hold breath about 3 to 5 seconds before exhaling. (ATI page 138)
-Position the mouthpiece 2.5 cm (1 in) from the mouth.
3. A nurse is assessing a client who is 12 hr. postoperative following a colon resection. Which of
the following findings should the nurse report to the surgeon?
-Heart rate 90/mm
-Hgb 8.2 g/dL
-Gastric ph of 3.0
-Absent bowel sounds
Recall that bowel sounds are altered in patients with obstruction; absent bowel sounds imply
total obstruction. QSEN: Safety (Book page 1143)
4. A nurse is caring for a client who has diabetes insipidus. Which of the following medications
should the nurse plan to administer?
-Regular Insulin
-Furosemide
-Desmopressin
-Lithium Carbonate
Teach patients with diabetes insipidus the proper way to self-administer desmopressin orally or
by nasal spray.
Management focuses on controlling symptoms with drug therapy.
-The most preferred drug is desmopressin acetate (DDAVP), a synthetic form of vasopressin
given orally, as a sublingual “melt,” or intranasally in a metered spray. The frequency of
dosing varies with patient responses. Teach patients that each metered spray delivers 10 mcg
and those with mild DI may need only one or two doses in 24 hours.
-For more severe DI, one or two metered doses two or three times daily may be needed.
5. A nurse is admitting a client who has arthritic pain and reports taking ibuprofen several times
daily for 3 years. Which of the following test should the nurse monitor?
Stool occult blood
-Urine for white blood cells
-Fasting blood glucose
-Serum calcium
,Assess for drug-related blood loss such as that caused by NSAIDs by checking the stool for
gross or occult blood. Older white women are the most likely to experience GI bleeding as a
result of taking these medications. (Book page 324)
6. A nurse in the emergency department is assessing a client. Which of the following actions
should the nurse take first? (Click on the “Exhibit” button for additional information about the
client. There are three tabs that contain separate categories of data.)
-Obtain a sputum sample for culture.
-Prepare the client for a chest x-ray.
-Initiate airborne precautions (question sounds like a respiratory issue)
-Administer ondansetron.
7. A nurse is contacting the provider of a client who has cancer and is experiencing
breakthrough pain. Which of the following prescriptions should the nurse anticipate?
-Intravenous dexamethasone
-Transmucosal fentanyl
-Oral acetaminophen- not strong enough
-Intramuscular meperidine
Fentanyl is a lipophilic (readily absorbed in fatty tissue) opioid and, as such, has a fast onset
and short duration of action. It is recommended opioid for patients with end-organ failure
because it has no clinically relevant metabolites. It also produces fewer hemodynamic adverse
effects than other opioids; therefore, it is often preferred in patients who are hemodynamically
unstable such as the critically ill. (Book page 59)
8. A nurse is admitting a client who reports chest pain and has been placed on a telemetry
monitor. Which of the following should the nurse analyze to determine whether the client is
experiencing a myocardial infarction?
-QRS duration
-ST segment
-T-wave
PR interval
Examine the ST segment. The normal ST segment begins at the isoelectric line. ST elevation
or depression is significant if displacement is 1 mm (one small box) or more above or below
the line and is seen in two or more leads. ST elevation may indicate problems such as
myocardial infarction, pericarditis, and hyperkalemia. ST depression is associated with
hypokalemia, myocardial infarction, or ventricular hypertrophy. (Book page 670)
9. A nurse is teaching a client who has ovarian cancer about skin care following radiation
treatment. Which of the following instructions should the nurse include?
-Apply over the counter moisturizer to the radiation site
-Cover the radiation site loosely with a gauze wrap before dressing
-Use a soft washcloth to clean the area around the radiation site
-Pat the skin on the radiation site to dry it. (Book page 390)
Skin Protection During Radiation Therapy
• Wash the irradiated area gently each day with either water or a mild soap and water as
prescribed by your radiation therapy team.
, • Use your hand rather than a washcloth when cleansing the therapy site to be gentler.
• Rinse soap thoroughly from your skin.
• If ink or dye markings are present to identify exactly where the beam of radiation is to be
focused, take care not to remove them.
• Dry the irradiated area with patting rather than rubbing motions; use a clean, soft towel or
cloth.
• Use only powders, ointments, lotions, or creams that are prescribed by the radiation oncology
department on your skin at the radiation site.
• Wear soft clothing over the skin at the radiation site.
• Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the
radiation site.
• Avoid exposure of the irradiated area to the sun:
• Protect this area by wearing clothing over it.
• Try to go outdoors in the early morning or evening to avoid the more intense sun rays.
• When outdoors, stay under awnings, umbrellas, and other forms of shade during the times when
the sun's rays are most intense (10 AM to 7 PM).
• Avoid heat exposure.
10. A nurse is caring for a client who is receiving a blood transfusion. The nurse observes that
the client has bounding peripheral pulses, hypertension, and distended jugular veins. The nurse
should anticipate administering which of the following prescribed medications?
Acetaminophen
-Furosemide (this patient has fluid overload from the transfusion)
Diphenhydramine
Pantoprazole
11. A nurse is assessing a client who is receiving magnesium sulfate IV for the treatment of
hypomagnesemia. Which of the following findings indicates effectiveness of the medication?
-Lungs clear
-Hypoactive bowel sounds- Reduced motility, anorexia, nausea, constipation, and abdominal
distention are common. A paralytic ileus may occur when hypomagnesemia is severe.
-Blood pressure 90/50 mm Hg-hypomagnesemia causes hypertension, but this is too low,
abnormal
-Apical pulse 82/min
One aspect of the conduction problems is that, when serum magnesium levels are low,
intracellular potassium levels are also low. This changes the resting membrane potential in
cardiac muscle cells, slowing normal conduction and triggering ectopic beats.
12. A nurse is preparing a client for a lumbar puncture. Which of the following images indicates
the position the nurse should assist the client into for this procedure?
- “Cannonball position on the side” picture #4 (ATI page 20)
ATI Proctored Exam Medical Surgical Form A
1. A nurse is preparing to administer thrombolytic therapy to a client who had an ischemic
stroke. Which of the following is an appropriate nursing action?
-Start the therapy within 8 hrs. (within 6 hrs.)
-Insert an indwelling urinary catheter after therapy begins
-Monitor blood pressure every 30 minutes during infusion.
-Elevate the head of the bed between 25 and 30 degrees (to reduce ICP & promote venous
drainage, ATI page 89)
2. 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?
-Place hands on the upper abdomen during inhalation.
-Exhale slowly through pursed lips.
-Hold breath about 3 to 5 seconds before exhaling. (ATI page 138)
-Position the mouthpiece 2.5 cm (1 in) from the mouth.
3. A nurse is assessing a client who is 12 hr. postoperative following a colon resection. Which of
the following findings should the nurse report to the surgeon?
-Heart rate 90/mm
-Hgb 8.2 g/dL
-Gastric ph of 3.0
-Absent bowel sounds
Recall that bowel sounds are altered in patients with obstruction; absent bowel sounds imply
total obstruction. QSEN: Safety (Book page 1143)
4. A nurse is caring for a client who has diabetes insipidus. Which of the following medications
should the nurse plan to administer?
-Regular Insulin
-Furosemide
-Desmopressin
-Lithium Carbonate
Teach patients with diabetes insipidus the proper way to self-administer desmopressin orally or
by nasal spray.
Management focuses on controlling symptoms with drug therapy.
-The most preferred drug is desmopressin acetate (DDAVP), a synthetic form of vasopressin
given orally, as a sublingual “melt,” or intranasally in a metered spray. The frequency of
dosing varies with patient responses. Teach patients that each metered spray delivers 10 mcg
and those with mild DI may need only one or two doses in 24 hours.
-For more severe DI, one or two metered doses two or three times daily may be needed.
5. A nurse is admitting a client who has arthritic pain and reports taking ibuprofen several times
daily for 3 years. Which of the following test should the nurse monitor?
Stool occult blood
-Urine for white blood cells
-Fasting blood glucose
-Serum calcium
,Assess for drug-related blood loss such as that caused by NSAIDs by checking the stool for
gross or occult blood. Older white women are the most likely to experience GI bleeding as a
result of taking these medications. (Book page 324)
6. A nurse in the emergency department is assessing a client. Which of the following actions
should the nurse take first? (Click on the “Exhibit” button for additional information about the
client. There are three tabs that contain separate categories of data.)
-Obtain a sputum sample for culture.
-Prepare the client for a chest x-ray.
-Initiate airborne precautions (question sounds like a respiratory issue)
-Administer ondansetron.
7. A nurse is contacting the provider of a client who has cancer and is experiencing
breakthrough pain. Which of the following prescriptions should the nurse anticipate?
-Intravenous dexamethasone
-Transmucosal fentanyl
-Oral acetaminophen- not strong enough
-Intramuscular meperidine
Fentanyl is a lipophilic (readily absorbed in fatty tissue) opioid and, as such, has a fast onset
and short duration of action. It is recommended opioid for patients with end-organ failure
because it has no clinically relevant metabolites. It also produces fewer hemodynamic adverse
effects than other opioids; therefore, it is often preferred in patients who are hemodynamically
unstable such as the critically ill. (Book page 59)
8. A nurse is admitting a client who reports chest pain and has been placed on a telemetry
monitor. Which of the following should the nurse analyze to determine whether the client is
experiencing a myocardial infarction?
-QRS duration
-ST segment
-T-wave
PR interval
Examine the ST segment. The normal ST segment begins at the isoelectric line. ST elevation
or depression is significant if displacement is 1 mm (one small box) or more above or below
the line and is seen in two or more leads. ST elevation may indicate problems such as
myocardial infarction, pericarditis, and hyperkalemia. ST depression is associated with
hypokalemia, myocardial infarction, or ventricular hypertrophy. (Book page 670)
9. A nurse is teaching a client who has ovarian cancer about skin care following radiation
treatment. Which of the following instructions should the nurse include?
-Apply over the counter moisturizer to the radiation site
-Cover the radiation site loosely with a gauze wrap before dressing
-Use a soft washcloth to clean the area around the radiation site
-Pat the skin on the radiation site to dry it. (Book page 390)
Skin Protection During Radiation Therapy
• Wash the irradiated area gently each day with either water or a mild soap and water as
prescribed by your radiation therapy team.
, • Use your hand rather than a washcloth when cleansing the therapy site to be gentler.
• Rinse soap thoroughly from your skin.
• If ink or dye markings are present to identify exactly where the beam of radiation is to be
focused, take care not to remove them.
• Dry the irradiated area with patting rather than rubbing motions; use a clean, soft towel or
cloth.
• Use only powders, ointments, lotions, or creams that are prescribed by the radiation oncology
department on your skin at the radiation site.
• Wear soft clothing over the skin at the radiation site.
• Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the
radiation site.
• Avoid exposure of the irradiated area to the sun:
• Protect this area by wearing clothing over it.
• Try to go outdoors in the early morning or evening to avoid the more intense sun rays.
• When outdoors, stay under awnings, umbrellas, and other forms of shade during the times when
the sun's rays are most intense (10 AM to 7 PM).
• Avoid heat exposure.
10. A nurse is caring for a client who is receiving a blood transfusion. The nurse observes that
the client has bounding peripheral pulses, hypertension, and distended jugular veins. The nurse
should anticipate administering which of the following prescribed medications?
Acetaminophen
-Furosemide (this patient has fluid overload from the transfusion)
Diphenhydramine
Pantoprazole
11. A nurse is assessing a client who is receiving magnesium sulfate IV for the treatment of
hypomagnesemia. Which of the following findings indicates effectiveness of the medication?
-Lungs clear
-Hypoactive bowel sounds- Reduced motility, anorexia, nausea, constipation, and abdominal
distention are common. A paralytic ileus may occur when hypomagnesemia is severe.
-Blood pressure 90/50 mm Hg-hypomagnesemia causes hypertension, but this is too low,
abnormal
-Apical pulse 82/min
One aspect of the conduction problems is that, when serum magnesium levels are low,
intracellular potassium levels are also low. This changes the resting membrane potential in
cardiac muscle cells, slowing normal conduction and triggering ectopic beats.
12. A nurse is preparing a client for a lumbar puncture. Which of the following images indicates
the position the nurse should assist the client into for this procedure?
- “Cannonball position on the side” picture #4 (ATI page 20)
