NGN ATI RN MED SURG PROCTORED EXAM 100 QUESTIONS WITH DETAILED VERIFIED ANSWERS (100% CORRECT ANSWERS) /A+ GRADE ASSURED/ VERSION
A nurse is caring for a client who experienced a traumatic head injury and has an intraventricular catheter (Ventriculostomy) for ICP monitoring. The nurse should monitor the client for which of the following complications related to the ventriculostomy?:
a. Headache
b. Infection
c. Aphasia
d. Hypertension - ANSWER b. Infection
Monitor for infection and use strict asepsis to avoid life-threatening meningitis.
A nurse is providing education to a client who is to undergo an EEG the next day. Which of the following info should the nurse include in the teaching?
a. "Do not wash your hair the morning of the procedure."
b. "Try and stay awake most of the night prior to the procedure."
c. "The procedure will take approximately 15 mins."
d. "You will need to lie flat for 4 hours after the procedure." - ANSWER b. "Try and stay awake most of the night prior to the procedure."
Tell the client to remain awake to provide cranial stress and increase the possibility of abnormal electrical activity
A nurse is caring for a client who is postprocedural following a lumbar puncture and reports a throbbing headache when sitting upright. Which of the following actions should the nurse take? SATA.
a. Use the GCS scale to assess the client
b. Assist the client into a supine position
c. Administer an opioid analgesic
d. Encourage the client to increase PO fluid intake
e. Instruct the client to perform coughing and deep breathing - ANSWER B, D
A nurse is caring for a client who has continuous bladder irrigation following a transurethral resection of the prostate (TURP). Which of the following findings should
the nurse report to the provider?
a Output equal to the instilled irrigate
b. Client reports bladder spasms
c. Viscous urinary output with clots d. Reports of strong urge to urinate - ANSWER c. Viscous urinary output with clots
Urine that is bright red with clots is an indication of arterial bleeding.
A nurse is monitoring the ECG of a client who has hypocalcemia. Which of the following findings should the nurse expect?
a. Flattened T waves
b. Prolonged QT intervals
c. Shortened QT intervals
d Widened QRS complexes - ANSWER b. Prolonged QT intervals
Manifestations of hypocalcemia include tingling, numbness, tetany, seizures, prolonged QT intervals, and laryngospasm.
A nurse is preparing a client who has a brain tumor for a CT scan. Which of the following factors affects the manner in which the nurse will prepare the client for the scan?
a. No food or fluids consumed for 4 hours
b. Difficulty recalling recent events
c. Development of hives while eating shrimp
d. Paresthesia in both hands - ANSWER c. Development of hives while eating shrimp
Shellfish allergy is contraindication of use of contrast media during a CT scan.
A nurse is preparing an in-service program about the stages of acute kidney injury. Which of the following pieces of info should the nurse include about prerenal azotemia?
a. Prerenal azotemia begins prior to the onset of symptoms
b. Interference with renal perfusion causes renal azotemia
c. Prerenal azotemia is irreversible, even in early stages
d. Infections and tumors cause prerenal azotemia - ANSWER b. Interference with renal perfusion causes prerenal azotemia.
Prerenal = interference with renal perfusion, such as from heart failure or hypovolemic shock.
A nurse is teaching a client who has CAD about the difference between angina pectoris and MI. Which of the following should the nurse identify as indications of MI? SATA.
a. N/V
b. Diaphoresis and dizziness
c. Chest and left arm pain that subsides with rest
d. Anxiety and feelings of doom
e. Bounding pulse and bradypnea - ANSWER A, B, D
A nurse is reviewing the lab results of a lumbar puncture for a client who has manifestations of bacterial meningitis. Which of the following findings should the nurse expect? a. Elevated glucose
b. Elevated protein
c. Presence of RBCs
d. Presence of D-dimer - ANSWER b. Elevated protein
Manifestations of bacterial meningitis include increase protein in the CSF, decreased
glucose. RBCs can indicate bleeding, however, WBCs are what indicates bacterial meningitis.
A nurse is providing teaching to a client who has a new diagnosis of myasthenia gravis (MG). Which of the following pieces of information should the nurse include?
A. Use enemas to treat constipation caused by daily medications
B. Take a hot bath when muscles ache
C. Eat a low-calorie diet
D. Set an alarm to ensure medication dosages are taken on time - ANSWER D. Set an alarm to ensure medication dosages are taken on time
The nurse should instruct the client to take medication dosages on time to maintain a
therapeutic blood level. Dosages should not be missed or postponed because this can cause an exacerbation of the disease.
A nurse is teaching a client who has a new diagnosis of primary open-angle glaucoma (POAG). Which of the following pieces of information should the nurse include in the teaching? (Select all that apply.)
A. Lost vision can improve with eye drops.
B. Administer eye drops as needed for vision loss.
C. Glasses will be necessary to correct the accompanying presbyopia.
D. Driving can be dangerous due to the loss of peripheral vision.
E. Laser surgery can help reestablish the flow of aqueous humor. - ANSWER D. Driving can be dangerous due to the loss of peripheral vision.
E. Laser surgery can help reestablish the flow of aqueous humor.
A nurse is assessing a client who has a fractured left femur and is in skeletal traction. Which of the following findings should the nurse report to the provider?
A. Ecchymosis of the thigh
B. Serous drainage at the pin site
C. Chest petechiae
D. Muscle spasms in the left leg - ANSWER C. Chest petechiae
The nurse should identify chest petechiae as an indication of fat embolism syndrome. Clients who have fractures of the long bones such as the femur are at increased risk of fat emboli. Fat emboli typically occur 12 to 48 hours after the injury when fat droplets from the marrow enter into the systemic circulation and are deposited in the lungs. The nurse should immediately notify the provider because the
client could progress to acute respiratory failure.
A nurse is caring for a client who experienced a traumatic head injury and has an intraventricular catheter (Ventriculostomy) for ICP monitoring. The nurse should monitor the client for which of the following complications related to the ventriculostomy?:
a. Headache
b. Infection
c. Aphasia
d. Hypertension - ANSWER b. Infection
Monitor for infection and use strict asepsis to avoid life-threatening meningitis.
A nurse is providing education to a client who is to undergo an EEG the next day. Which of the following info should the nurse include in the teaching?
a. "Do not wash your hair the morning of the procedure."
b. "Try and stay awake most of the night prior to the procedure."
c. "The procedure will take approximately 15 mins."
d. "You will need to lie flat for 4 hours after the procedure." - ANSWER b. "Try and stay awake most of the night prior to the procedure."
Tell the client to remain awake to provide cranial stress and increase the possibility of abnormal electrical activity
A nurse is caring for a client who is postprocedural following a lumbar puncture and reports a throbbing headache when sitting upright. Which of the following actions should the nurse take? SATA.
a. Use the GCS scale to assess the client
b. Assist the client into a supine position
c. Administer an opioid analgesic
d. Encourage the client to increase PO fluid intake
e. Instruct the client to perform coughing and deep breathing - ANSWER B, D
A nurse is caring for a client who has continuous bladder irrigation following a transurethral resection of the prostate (TURP). Which of the following findings should
the nurse report to the provider?
a Output equal to the instilled irrigate
b. Client reports bladder spasms
c. Viscous urinary output with clots d. Reports of strong urge to urinate - ANSWER c. Viscous urinary output with clots
Urine that is bright red with clots is an indication of arterial bleeding.
A nurse is monitoring the ECG of a client who has hypocalcemia. Which of the following findings should the nurse expect?
a. Flattened T waves
b. Prolonged QT intervals
c. Shortened QT intervals
d Widened QRS complexes - ANSWER b. Prolonged QT intervals
Manifestations of hypocalcemia include tingling, numbness, tetany, seizures, prolonged QT intervals, and laryngospasm.
A nurse is preparing a client who has a brain tumor for a CT scan. Which of the following factors affects the manner in which the nurse will prepare the client for the scan?
a. No food or fluids consumed for 4 hours
b. Difficulty recalling recent events
c. Development of hives while eating shrimp
d. Paresthesia in both hands - ANSWER c. Development of hives while eating shrimp
Shellfish allergy is contraindication of use of contrast media during a CT scan.
A nurse is preparing an in-service program about the stages of acute kidney injury. Which of the following pieces of info should the nurse include about prerenal azotemia?
a. Prerenal azotemia begins prior to the onset of symptoms
b. Interference with renal perfusion causes renal azotemia
c. Prerenal azotemia is irreversible, even in early stages
d. Infections and tumors cause prerenal azotemia - ANSWER b. Interference with renal perfusion causes prerenal azotemia.
Prerenal = interference with renal perfusion, such as from heart failure or hypovolemic shock.
A nurse is teaching a client who has CAD about the difference between angina pectoris and MI. Which of the following should the nurse identify as indications of MI? SATA.
a. N/V
b. Diaphoresis and dizziness
c. Chest and left arm pain that subsides with rest
d. Anxiety and feelings of doom
e. Bounding pulse and bradypnea - ANSWER A, B, D
A nurse is reviewing the lab results of a lumbar puncture for a client who has manifestations of bacterial meningitis. Which of the following findings should the nurse expect? a. Elevated glucose
b. Elevated protein
c. Presence of RBCs
d. Presence of D-dimer - ANSWER b. Elevated protein
Manifestations of bacterial meningitis include increase protein in the CSF, decreased
glucose. RBCs can indicate bleeding, however, WBCs are what indicates bacterial meningitis.
A nurse is providing teaching to a client who has a new diagnosis of myasthenia gravis (MG). Which of the following pieces of information should the nurse include?
A. Use enemas to treat constipation caused by daily medications
B. Take a hot bath when muscles ache
C. Eat a low-calorie diet
D. Set an alarm to ensure medication dosages are taken on time - ANSWER D. Set an alarm to ensure medication dosages are taken on time
The nurse should instruct the client to take medication dosages on time to maintain a
therapeutic blood level. Dosages should not be missed or postponed because this can cause an exacerbation of the disease.
A nurse is teaching a client who has a new diagnosis of primary open-angle glaucoma (POAG). Which of the following pieces of information should the nurse include in the teaching? (Select all that apply.)
A. Lost vision can improve with eye drops.
B. Administer eye drops as needed for vision loss.
C. Glasses will be necessary to correct the accompanying presbyopia.
D. Driving can be dangerous due to the loss of peripheral vision.
E. Laser surgery can help reestablish the flow of aqueous humor. - ANSWER D. Driving can be dangerous due to the loss of peripheral vision.
E. Laser surgery can help reestablish the flow of aqueous humor.
A nurse is assessing a client who has a fractured left femur and is in skeletal traction. Which of the following findings should the nurse report to the provider?
A. Ecchymosis of the thigh
B. Serous drainage at the pin site
C. Chest petechiae
D. Muscle spasms in the left leg - ANSWER C. Chest petechiae
The nurse should identify chest petechiae as an indication of fat embolism syndrome. Clients who have fractures of the long bones such as the femur are at increased risk of fat emboli. Fat emboli typically occur 12 to 48 hours after the injury when fat droplets from the marrow enter into the systemic circulation and are deposited in the lungs. The nurse should immediately notify the provider because the
client could progress to acute respiratory failure.
