ATI RN ADULT MED SURGE PREDICTOR
EXAM 90 QUESTIONS AND ANSWERS WITH
RATIONALES 2023-2024|A+ GRADED|
1. a nurse is assessing a client who had extracorporeal shock wake lithotripsy (ESWL) 6 hr
ago. which of the following findings should the nurse expect?
ANS: stone fragments in the urine
RATIONALE: ESWL is an effort to break the calculi so that the fragments pass down the
ureter, into the bladder, and through the urethra during voiding. Following the procedure,
the nurse should strain the client's urine to confirm the passage of stones.
2. a nurse is assessing a group of clients for indications of role changes. the nurse should
identify that which of the following clients is at risk for experiencing a role change?
ANS: 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.
3. a nurse is caring for a client who has a new diagnosis of hyperthyroidism. which of the
following is the priority assessment finding that the nurse should report to the provider?
ANS: blood pressure 170/80 mm Hg
RATIONALE: Using the urgent vs. nonurgent approach to client care, the nurse should
determine that the priority finding is a systolic blood pressure of 170 mm Hg, which
indicates that the client is at risk for thyroid storm.
,4. a nurse is providing discharge instructions to a client who has a partial-thickness burn on
the hand. which of the following instructions should the nurse include?
ANS: wrap fingers with individual dressings.
RATIONALE: The nurse should instruct the client to wrap the fingers individually to
allow for functional use of the hand while healing occurs. The nurse should also instruct
the client to perform range-of-motion exercises to each finger every hour while awake to
promote function of the injured hand.
5. a nurse is providing teaching to a client who is receiving chemotherapy and has a new
prescription for epoetin alfa. which of the following client statements indicates an
understanding of the teaching?
ANS: I will monitor my blood pressure while taking this medication
6. a nurse is providing discharge teaching to a client who has heart failure and a new
prescription for a potassium-sparing diuretic. which of the following information should
the nurse include in the teaching?
ANS: try to walk at least three times per week for exercise.
RATIONALE: The development of a regular exercise routine can improve outcomes in
clients who have heart failure.
7. a nurse is caring for a client who has HIV. which of the following findings indicates a
positive response to the prescribed HIV treatment?
ANS: decreased viral load
, RATIONALE: Viral load testing measures the presence of HIV viral genetic material.
Therefore, a decreased viral load indicates a positive response to the prescribed HIV
treatment.
8. a nurse is caring for a client who is postoperative following a total hip arthroplasty. which
of the following laboratory values should the nurse report to the provider?
ANS: Hgb 8 g/dL
RATIONALE: The nurse should report an Hgb level of 8 g/dL, which is below the
expected reference range and is an indicator of postoperative hemorrhage or anemia.
9. a nurse is assessing a client who has had a plaster cast applied to their left leg 2 hr ago.
which of the following actions should the nurse take?
ANS: check that one finger fits between the cast and the leg.
RATIONALE: To make sure the cast is not too tight, the nurse should be able to slide
one finger under the cast. It is not uncommon for casts to loosen as swelling subsides, but
that should not be an issue 2 hr after application.
10. a nurse is providing teaching to a client who has chronic kidney disease and a new
prescription for erythropoietin. which of the following statements by the client indicates
and understanding of the teaching?
ANS: "I am taking this medication to increase my energy level."
RATIONALE: The goal of erythropoietin therapy is to increase the level of hematocrit in
clients who have anemia. When the medication is effective, the client should have a
decrease in fatigue and an improvement in activity tolerance.
EXAM 90 QUESTIONS AND ANSWERS WITH
RATIONALES 2023-2024|A+ GRADED|
1. a nurse is assessing a client who had extracorporeal shock wake lithotripsy (ESWL) 6 hr
ago. which of the following findings should the nurse expect?
ANS: stone fragments in the urine
RATIONALE: ESWL is an effort to break the calculi so that the fragments pass down the
ureter, into the bladder, and through the urethra during voiding. Following the procedure,
the nurse should strain the client's urine to confirm the passage of stones.
2. a nurse is assessing a group of clients for indications of role changes. the nurse should
identify that which of the following clients is at risk for experiencing a role change?
ANS: 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.
3. a nurse is caring for a client who has a new diagnosis of hyperthyroidism. which of the
following is the priority assessment finding that the nurse should report to the provider?
ANS: blood pressure 170/80 mm Hg
RATIONALE: Using the urgent vs. nonurgent approach to client care, the nurse should
determine that the priority finding is a systolic blood pressure of 170 mm Hg, which
indicates that the client is at risk for thyroid storm.
,4. a nurse is providing discharge instructions to a client who has a partial-thickness burn on
the hand. which of the following instructions should the nurse include?
ANS: wrap fingers with individual dressings.
RATIONALE: The nurse should instruct the client to wrap the fingers individually to
allow for functional use of the hand while healing occurs. The nurse should also instruct
the client to perform range-of-motion exercises to each finger every hour while awake to
promote function of the injured hand.
5. a nurse is providing teaching to a client who is receiving chemotherapy and has a new
prescription for epoetin alfa. which of the following client statements indicates an
understanding of the teaching?
ANS: I will monitor my blood pressure while taking this medication
6. a nurse is providing discharge teaching to a client who has heart failure and a new
prescription for a potassium-sparing diuretic. which of the following information should
the nurse include in the teaching?
ANS: try to walk at least three times per week for exercise.
RATIONALE: The development of a regular exercise routine can improve outcomes in
clients who have heart failure.
7. a nurse is caring for a client who has HIV. which of the following findings indicates a
positive response to the prescribed HIV treatment?
ANS: decreased viral load
, RATIONALE: Viral load testing measures the presence of HIV viral genetic material.
Therefore, a decreased viral load indicates a positive response to the prescribed HIV
treatment.
8. a nurse is caring for a client who is postoperative following a total hip arthroplasty. which
of the following laboratory values should the nurse report to the provider?
ANS: Hgb 8 g/dL
RATIONALE: The nurse should report an Hgb level of 8 g/dL, which is below the
expected reference range and is an indicator of postoperative hemorrhage or anemia.
9. a nurse is assessing a client who has had a plaster cast applied to their left leg 2 hr ago.
which of the following actions should the nurse take?
ANS: check that one finger fits between the cast and the leg.
RATIONALE: To make sure the cast is not too tight, the nurse should be able to slide
one finger under the cast. It is not uncommon for casts to loosen as swelling subsides, but
that should not be an issue 2 hr after application.
10. a nurse is providing teaching to a client who has chronic kidney disease and a new
prescription for erythropoietin. which of the following statements by the client indicates
and understanding of the teaching?
ANS: "I am taking this medication to increase my energy level."
RATIONALE: The goal of erythropoietin therapy is to increase the level of hematocrit in
clients who have anemia. When the medication is effective, the client should have a
decrease in fatigue and an improvement in activity tolerance.
