ATI MED SURGE PROCTORED EXAM 2019
FORM B
,1. A nurse is caring for a client who has Cushing's syndrome. Which of the following clinical
manifestations should the nurse expect to observe? (Select all that apply.)
1) Buffalo hump
2) Purple striations
3) Moon face
INCORRECT
4) Tremors
INCORRECT
5) Obese extremities
Answer Rationale:
Buffalo hump is correct. Cushing's syndrome is a disease caused by an increased production ofcortisol or by excessive use
of corticosteroids. Buffalo hump, a collection of fat between the shoulders, is a common manifestation of Cushing's
syndrome.Purple striations is correct.
Purple striations on the skin of the abdomen, thighs, and breasts are a common manifestation ofCushing's syndrome.
This is due to the collection of body fat in these areas.Moon face is correct. Moon face is a common manifestation of
Cushing's syndrome. Clients who have this manifestation present with a round, red, full face.Tremors is
Downloaded by: tbosse4 |
, Distribution of this document is illegal
Stuvia.com - The Marketplace to Buy and Sell your Study Material
incorrect. Tremors are not a common finding of Cushing's syndrome.Obese extremities is incorrect. Clients who have
Cushing's syndrome have truncal obesity, a protuberant abdomen,with thin extremities, which is due to an alteration in
protein metabolism.
2. A nurse is assisting with the care of a client immediately following a lumbar puncture. Which
of the following actions should the nurse take? (Select all that apply.)
1) Encourage fluid intake.
2) Monitor the puncture site for hematoma.
INCORRECT
3) Insert a urinary catheter.
INCORRECT
4) Elevate the client’s head of bed.
INCORRECT
5) Apply a cervical collar to the client.
Answer Rationale:
Encourage fluid intake is correct. The nurse should encourage fluids, unless contraindicated, toreplace the cerebrospinal
fluid that was removed during the procedure and reduce the risk for a headache.
Monitor the puncture site for a hematoma is correct. The nurse should monitor and report a
hematoma at the insertion site because this can indicate bleeding.
Insert a urinary catheter is incorrect. There is no indication for a urinary catheter insertion.
Elevate the client’s head of bed is incorrect. The client should remain flat in bed for 1 hr ormore
to reduce the risk for a headache.
Apply a cervical collar to the client is incorrect. There is no indication for a cervical collar forthis
client.
3. A nurse is reinforcing pre-operative teaching for a client who is scheduled for surgery and is to
take hydroxyzine preoperatively. Which of the following effects of the medication should the
nurse include in the teaching? (Select all that apply.)
1) Decreasing anxiety
2) Controlling emesis
INCORRECT
3) Relaxing skeletal muscles
INCORRECT
4) Preventing surgical site infections
5) Reducing the amount of narcotics needed for pain relief
Downloaded by: tbosse4 |
Distribution of this document is illegal
, Stuvia.com - The Marketplace to Buy and Sell your Study Material
Answer Rationale:
Decreasing anxiety is correct. The nurse should include that hydroxyzine is an effective antianxiety agent and is used to
decrease anxiety in surgical clients as well as in persons withmoderate anxiety.
Controlling emesis is correct. The nurse should include that hydroxyzine is an effectiveantiemetic and is used to control
nausea and vomiting in pre- and postoperative clients.
Relaxing skeletal muscles is incorrect. The nurse should recognize benzodiazepines, such as
diazepam (Valium), are used to produce skeletal muscle relaxation.
Preventing surgical site infections is incorrect. The nurse should instruct the client that antibiotics administered prior to
surgery are used to diminish the risk of surgical site infections;hydroxyzine, an antiemetic, does not have any effect on
bacteria.
Reducing the amount of narcotics needed for pain relief is correct. Hydroxyzine increases the
effects of narcotic pain medications. The nurse should instruct the client that when it is used for
surgical clients, narcotic requirements may be significantly reduced.
4. A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus. The nurse
determines that teaching has been effective when the client identifies which of the following
manifestations of hypoglycemia? (Select all that apply.)
INCORRECT
1) Polyuria
2) Blurry vision
3) Tachycardia
INCORRECT
4) Polydipsia
5) Sweating
Answer Rationale:
Polyuria is incorrect. Hyperglycemia causes polyuria.
Blurry vision is correct. Manifestations of hypoglycemia include blurry vision, tremors, anxiety,irritability, headache, and
hypotension.
Tachycardia is correct. Manifestations of hypoglycemia include tachycardia, tremors, anxiety,irritability, headache, and
hypotension.
Polydipsia is incorrect. Hyperglycemia causes polydipsia.
Sweating is correct. Manifestations of hypoglycemia include sweating, tremors, anxiety,irritability, headache, and
hypotension.
Downloaded by: tbosse4 |
Distribution of this document is illegal
Stuvia.com - The Marketplace to Buy and Sell your Study Material
FORM B
,1. A nurse is caring for a client who has Cushing's syndrome. Which of the following clinical
manifestations should the nurse expect to observe? (Select all that apply.)
1) Buffalo hump
2) Purple striations
3) Moon face
INCORRECT
4) Tremors
INCORRECT
5) Obese extremities
Answer Rationale:
Buffalo hump is correct. Cushing's syndrome is a disease caused by an increased production ofcortisol or by excessive use
of corticosteroids. Buffalo hump, a collection of fat between the shoulders, is a common manifestation of Cushing's
syndrome.Purple striations is correct.
Purple striations on the skin of the abdomen, thighs, and breasts are a common manifestation ofCushing's syndrome.
This is due to the collection of body fat in these areas.Moon face is correct. Moon face is a common manifestation of
Cushing's syndrome. Clients who have this manifestation present with a round, red, full face.Tremors is
Downloaded by: tbosse4 |
, Distribution of this document is illegal
Stuvia.com - The Marketplace to Buy and Sell your Study Material
incorrect. Tremors are not a common finding of Cushing's syndrome.Obese extremities is incorrect. Clients who have
Cushing's syndrome have truncal obesity, a protuberant abdomen,with thin extremities, which is due to an alteration in
protein metabolism.
2. A nurse is assisting with the care of a client immediately following a lumbar puncture. Which
of the following actions should the nurse take? (Select all that apply.)
1) Encourage fluid intake.
2) Monitor the puncture site for hematoma.
INCORRECT
3) Insert a urinary catheter.
INCORRECT
4) Elevate the client’s head of bed.
INCORRECT
5) Apply a cervical collar to the client.
Answer Rationale:
Encourage fluid intake is correct. The nurse should encourage fluids, unless contraindicated, toreplace the cerebrospinal
fluid that was removed during the procedure and reduce the risk for a headache.
Monitor the puncture site for a hematoma is correct. The nurse should monitor and report a
hematoma at the insertion site because this can indicate bleeding.
Insert a urinary catheter is incorrect. There is no indication for a urinary catheter insertion.
Elevate the client’s head of bed is incorrect. The client should remain flat in bed for 1 hr ormore
to reduce the risk for a headache.
Apply a cervical collar to the client is incorrect. There is no indication for a cervical collar forthis
client.
3. A nurse is reinforcing pre-operative teaching for a client who is scheduled for surgery and is to
take hydroxyzine preoperatively. Which of the following effects of the medication should the
nurse include in the teaching? (Select all that apply.)
1) Decreasing anxiety
2) Controlling emesis
INCORRECT
3) Relaxing skeletal muscles
INCORRECT
4) Preventing surgical site infections
5) Reducing the amount of narcotics needed for pain relief
Downloaded by: tbosse4 |
Distribution of this document is illegal
, Stuvia.com - The Marketplace to Buy and Sell your Study Material
Answer Rationale:
Decreasing anxiety is correct. The nurse should include that hydroxyzine is an effective antianxiety agent and is used to
decrease anxiety in surgical clients as well as in persons withmoderate anxiety.
Controlling emesis is correct. The nurse should include that hydroxyzine is an effectiveantiemetic and is used to control
nausea and vomiting in pre- and postoperative clients.
Relaxing skeletal muscles is incorrect. The nurse should recognize benzodiazepines, such as
diazepam (Valium), are used to produce skeletal muscle relaxation.
Preventing surgical site infections is incorrect. The nurse should instruct the client that antibiotics administered prior to
surgery are used to diminish the risk of surgical site infections;hydroxyzine, an antiemetic, does not have any effect on
bacteria.
Reducing the amount of narcotics needed for pain relief is correct. Hydroxyzine increases the
effects of narcotic pain medications. The nurse should instruct the client that when it is used for
surgical clients, narcotic requirements may be significantly reduced.
4. A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus. The nurse
determines that teaching has been effective when the client identifies which of the following
manifestations of hypoglycemia? (Select all that apply.)
INCORRECT
1) Polyuria
2) Blurry vision
3) Tachycardia
INCORRECT
4) Polydipsia
5) Sweating
Answer Rationale:
Polyuria is incorrect. Hyperglycemia causes polyuria.
Blurry vision is correct. Manifestations of hypoglycemia include blurry vision, tremors, anxiety,irritability, headache, and
hypotension.
Tachycardia is correct. Manifestations of hypoglycemia include tachycardia, tremors, anxiety,irritability, headache, and
hypotension.
Polydipsia is incorrect. Hyperglycemia causes polydipsia.
Sweating is correct. Manifestations of hypoglycemia include sweating, tremors, anxiety,irritability, headache, and
hypotension.
Downloaded by: tbosse4 |
Distribution of this document is illegal
Stuvia.com - The Marketplace to Buy and Sell your Study Material
