ATI Med Surg Practice A 2023 with
rationales(rated A+)!!
A nurse is reinforcing teaching with a client who has mitral valve disease. Which of
following statements by the client indicates an understanding of the disease process?
A. "I should call my doctor if I get a headache."
B. "I might develop gastric reflux."
C. "I might develop excessive bruising."
D. "I should call my doctor if my ankles swell." - ANSWER-D. "I should call my doctor if
my ankles swell."
RAT: Swelling of the ankles can indicate heart failure. The client should report this
finding to the provider.
-A provider might prescribe anticoagulants to prevent thrombus formation on the valve,
which can cause excessive bruising for a client who has mitral valve disease. However,
excessive bruising is not a direct result of the disease.
A nurse is reinforcing teaching about joint protection with a client who has an acute
exacerbation of rheumatoid arthritis. Which of the following information should the nurse
include in the teaching?
A. Apply cold packs to the inflamed joints.
B. Participate in high-impact exercise.
C. Carry a hand purse rather than a shoulder bag.
D. Sleep on a soft foam mattress. - ANSWER-A. Apply cold packs to the inflamed joints.
RAT: The nurse should instruct the client to use both warm and cold packs on inflamed
joints to decrease pain.
A nurse is collecting data from who has hypothyroidism. Which of the following
manifestations should the nurse anticipate?
A. Blurred vision
B. Insomnia
C. Bradycardia
D. Weight loss - ANSWER-C. Bradycardia
-The nurse should identify that blurred vision is a manifestation of hyperthyroidism
-The nurse should identify that insomnia is a manifestation of hyperthyroidism that is
caused by an increase in the client's metabolic rate.
,-The nurse should identify that weight loss is a manifestation of hyperthyroidism caused
by an increase in the client's metabolic rate.
RAT: The nurse should identify that bradycardia is a manifestation of hypothyroidism
that is caused by a decrease in the client's metabolic rate.
A nurse is reinforcing teaching with an adolescent child regarding testicular self-
examination. Which of the following statements by the client indicates an understanding
of the teaching?
A. "I will perform the exam before I shower."
B. "I will check my testicles every 6 months."
C. "I understand that testicular cancer is typically painless."
D. "I understand that pea-sized lumps are normal." - ANSWER-C. "I understand that
testicular cancer is typically painless."
RAT: Clients should report a lump that is not painful because testicular cancer is
typically painless. Clients should perform a testicular self-examination after a warm
shower. Clients should perform a testicular self-examination monthly.
A nurse is contributing to the plan of care of a client who is at risk for osteoporosis.
Which of the following interventions should the nurse include to prevent bone loss?
A. Increase fluid intake.
B. Encourage range-of-motion exercises.
C. Massage bony prominences.
D. Encourage weight-bearing exercises. - ANSWER-D. Encourage weight-bearing
exercises.
Weight-bearing exercises, such as walking, can maintain bone mass by reducing bone
demineralization, thus helping to prevent osteoporosis.
-Fluid intake is beneficial for general health and wellness, and it helps to treat some
disorders. Caffeine and alcohol intake can increase the client's risk for developing
osteoporosis. However, fluid intake does not prevent bone loss.
-Range-of-motion exercises are beneficial for general health and wellness, and they
help to maintain flexibility and prevent contractures. However, range-of-motion
exercises do not prevent bone loss.
-Massaging bony prominences should be avoided because it can traumatize deep
tissues.
A nurse is reinforcing teaching about management of constipation with a client who has
hypothyroidism. Which of the following instructions should the nurse include in the
teaching?
,A. Increase intake of fiber-rich foods.
B. Take a laxative every morning.
C. Maintain a fluid intake of 1,200 mL/day.
D. Limit activity to preserve energy. - ANSWER-A. Increase intake of fiber-rich foods.
RAT: The nurse should instruct the client to increase the amount of fiber-rich foods in
their diet. Dried beans and brown rice are examples of fiber-rich foods. The nurse
should instruct the client to increase activity to stimulate the evacuation of stool.
-The nurse should instruct the client to initially take a laxative in the evening to stimulate
the evacuation of stool. However, the nurse should instruct the client to use laxatives
sparingly.
-The nurse should instruct the client to increase their fluid intake to 2,000 mL/day to
maintain soft stools.
-The nurse should instruct the client to increase activity to stimulate the evacuation of
stool.
A home health nurse is reinforcing teaching with a client about preventing complications
of peripheral vascular disease. Which of the following statements indicates that the
client is adhering to the nurse's instructions?
A. "I apply rubbing alcohol to my feet every day to prevent infection."
B. "I will wear clean, knee-high wool socks every day to help improve my circulation."
C. "I use hot water bottles to keep my feet warm at night."
D. "I don't cross my legs anymore." - ANSWER-D. "I don't cross my legs anymore."
RAT: Clients who have peripheral vascular disease should not cross their legs because
it can impede circulation.
A nurse observes a client who is lying in bed and experiencing a tonic-clonic seizure.
Which of the following actions should the nurse take?
A. Lower the side rails of the client's bed.
B. Apply wrist restraints to the client.
C. Position the client in the semi-Fowler's position.
D. Loosen clothing around the client's neck. - ANSWER-D. Loosen clothing around the
client's neck.
RAT: The nurse should loosen clothing around the client's neck to maintain an open
airway and prevent aspiration.
, A nurse is reinforcing teaching with the caregiver of a client who is terminally ill about
manifestations of impending death. Which of the following manifestations should the
nurse include?
A. Incontinence of bowel and bladder
B. Increase in heart rate
C. Warmness of the skin
D. Hypertension - ANSWER-A. Incontinence of bowel and bladder
RAT: The nurse should inform the caregiver that incontinence of the bowel and bladder
is a manifestation of impending death. Other manifestations include hypotension,
bradycardia, restlessness, and coolness of the skin.
A nurse in an oncology clinic is reinforcing teaching about Mohs surgery with a client
who has skin cancer. Which of the following information should the nurse include in the
teaching?
A. Mohs surgery is a horizontal shaving of thin layers of the tumor.
Mohs surgery uses liquid nitrogen to destroy the cancerous tissue.
Mohs surgery is the preferred treatment for melanoma skin cancer.
Mohs surgery is a palliative treatment for metastatic skin cancer. - ANSWER-A. Mohs
surgery is a horizontal shaving of thin layers of the tumor.
RAT: Mohs surgery is performed to treat basal and squamous cell carcinoma. The
procedure, which involves a horizontal shaving of thin layers of a tumor, has a high
success rate.
-Cryosurgery, rather than Mohs surgery, uses liquid nitrogen to destroy cancerous
tissue.
-Mohs surgery is the preferred treatment for basal and squamous cell carcinoma. The
preferred treatment for melanoma is a wide, full thickness surgical excision.
-Radiation, rather than Mohs surgery, can be used as a palliative treatment for
metastatic skin cancer.
A nurse is assisting in the plan of care for a client who has 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. - ANSWER-Use simple verbal
cues when directing tasks.
rationales(rated A+)!!
A nurse is reinforcing teaching with a client who has mitral valve disease. Which of
following statements by the client indicates an understanding of the disease process?
A. "I should call my doctor if I get a headache."
B. "I might develop gastric reflux."
C. "I might develop excessive bruising."
D. "I should call my doctor if my ankles swell." - ANSWER-D. "I should call my doctor if
my ankles swell."
RAT: Swelling of the ankles can indicate heart failure. The client should report this
finding to the provider.
-A provider might prescribe anticoagulants to prevent thrombus formation on the valve,
which can cause excessive bruising for a client who has mitral valve disease. However,
excessive bruising is not a direct result of the disease.
A nurse is reinforcing teaching about joint protection with a client who has an acute
exacerbation of rheumatoid arthritis. Which of the following information should the nurse
include in the teaching?
A. Apply cold packs to the inflamed joints.
B. Participate in high-impact exercise.
C. Carry a hand purse rather than a shoulder bag.
D. Sleep on a soft foam mattress. - ANSWER-A. Apply cold packs to the inflamed joints.
RAT: The nurse should instruct the client to use both warm and cold packs on inflamed
joints to decrease pain.
A nurse is collecting data from who has hypothyroidism. Which of the following
manifestations should the nurse anticipate?
A. Blurred vision
B. Insomnia
C. Bradycardia
D. Weight loss - ANSWER-C. Bradycardia
-The nurse should identify that blurred vision is a manifestation of hyperthyroidism
-The nurse should identify that insomnia is a manifestation of hyperthyroidism that is
caused by an increase in the client's metabolic rate.
,-The nurse should identify that weight loss is a manifestation of hyperthyroidism caused
by an increase in the client's metabolic rate.
RAT: The nurse should identify that bradycardia is a manifestation of hypothyroidism
that is caused by a decrease in the client's metabolic rate.
A nurse is reinforcing teaching with an adolescent child regarding testicular self-
examination. Which of the following statements by the client indicates an understanding
of the teaching?
A. "I will perform the exam before I shower."
B. "I will check my testicles every 6 months."
C. "I understand that testicular cancer is typically painless."
D. "I understand that pea-sized lumps are normal." - ANSWER-C. "I understand that
testicular cancer is typically painless."
RAT: Clients should report a lump that is not painful because testicular cancer is
typically painless. Clients should perform a testicular self-examination after a warm
shower. Clients should perform a testicular self-examination monthly.
A nurse is contributing to the plan of care of a client who is at risk for osteoporosis.
Which of the following interventions should the nurse include to prevent bone loss?
A. Increase fluid intake.
B. Encourage range-of-motion exercises.
C. Massage bony prominences.
D. Encourage weight-bearing exercises. - ANSWER-D. Encourage weight-bearing
exercises.
Weight-bearing exercises, such as walking, can maintain bone mass by reducing bone
demineralization, thus helping to prevent osteoporosis.
-Fluid intake is beneficial for general health and wellness, and it helps to treat some
disorders. Caffeine and alcohol intake can increase the client's risk for developing
osteoporosis. However, fluid intake does not prevent bone loss.
-Range-of-motion exercises are beneficial for general health and wellness, and they
help to maintain flexibility and prevent contractures. However, range-of-motion
exercises do not prevent bone loss.
-Massaging bony prominences should be avoided because it can traumatize deep
tissues.
A nurse is reinforcing teaching about management of constipation with a client who has
hypothyroidism. Which of the following instructions should the nurse include in the
teaching?
,A. Increase intake of fiber-rich foods.
B. Take a laxative every morning.
C. Maintain a fluid intake of 1,200 mL/day.
D. Limit activity to preserve energy. - ANSWER-A. Increase intake of fiber-rich foods.
RAT: The nurse should instruct the client to increase the amount of fiber-rich foods in
their diet. Dried beans and brown rice are examples of fiber-rich foods. The nurse
should instruct the client to increase activity to stimulate the evacuation of stool.
-The nurse should instruct the client to initially take a laxative in the evening to stimulate
the evacuation of stool. However, the nurse should instruct the client to use laxatives
sparingly.
-The nurse should instruct the client to increase their fluid intake to 2,000 mL/day to
maintain soft stools.
-The nurse should instruct the client to increase activity to stimulate the evacuation of
stool.
A home health nurse is reinforcing teaching with a client about preventing complications
of peripheral vascular disease. Which of the following statements indicates that the
client is adhering to the nurse's instructions?
A. "I apply rubbing alcohol to my feet every day to prevent infection."
B. "I will wear clean, knee-high wool socks every day to help improve my circulation."
C. "I use hot water bottles to keep my feet warm at night."
D. "I don't cross my legs anymore." - ANSWER-D. "I don't cross my legs anymore."
RAT: Clients who have peripheral vascular disease should not cross their legs because
it can impede circulation.
A nurse observes a client who is lying in bed and experiencing a tonic-clonic seizure.
Which of the following actions should the nurse take?
A. Lower the side rails of the client's bed.
B. Apply wrist restraints to the client.
C. Position the client in the semi-Fowler's position.
D. Loosen clothing around the client's neck. - ANSWER-D. Loosen clothing around the
client's neck.
RAT: The nurse should loosen clothing around the client's neck to maintain an open
airway and prevent aspiration.
, A nurse is reinforcing teaching with the caregiver of a client who is terminally ill about
manifestations of impending death. Which of the following manifestations should the
nurse include?
A. Incontinence of bowel and bladder
B. Increase in heart rate
C. Warmness of the skin
D. Hypertension - ANSWER-A. Incontinence of bowel and bladder
RAT: The nurse should inform the caregiver that incontinence of the bowel and bladder
is a manifestation of impending death. Other manifestations include hypotension,
bradycardia, restlessness, and coolness of the skin.
A nurse in an oncology clinic is reinforcing teaching about Mohs surgery with a client
who has skin cancer. Which of the following information should the nurse include in the
teaching?
A. Mohs surgery is a horizontal shaving of thin layers of the tumor.
Mohs surgery uses liquid nitrogen to destroy the cancerous tissue.
Mohs surgery is the preferred treatment for melanoma skin cancer.
Mohs surgery is a palliative treatment for metastatic skin cancer. - ANSWER-A. Mohs
surgery is a horizontal shaving of thin layers of the tumor.
RAT: Mohs surgery is performed to treat basal and squamous cell carcinoma. The
procedure, which involves a horizontal shaving of thin layers of a tumor, has a high
success rate.
-Cryosurgery, rather than Mohs surgery, uses liquid nitrogen to destroy cancerous
tissue.
-Mohs surgery is the preferred treatment for basal and squamous cell carcinoma. The
preferred treatment for melanoma is a wide, full thickness surgical excision.
-Radiation, rather than Mohs surgery, can be used as a palliative treatment for
metastatic skin cancer.
A nurse is assisting in the plan of care for a client who has 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. - ANSWER-Use simple verbal
cues when directing tasks.
