ATI MED-SURG
1. A nurse is reinforcing discharge teaching about wound care with a family member of a
client who is postoperative. Which of the following should the nurse include in the teaching?
a) Administer an analgesic following wound care.(The nurse should remind the family
member to administer an analgesic prior to wound care to prevent discomfort.)
b) Irrigate the wound with povidone iodine.(The nurse should remind the family member to
irrigate the wound with 0.9% sodium chloride.)
c) Cleanse the wound with a cotton-tipped applicator.(The nurse should remind the family
member to avoid using a cotton-tipped applicator to cleanse the wound because the fibers
can become embedded in the wound, cause infection, and delay wound healing.)
d) Report purulent drainage to the provider.(The nurse should remind the family member to
report signs of infection, including purulent drainage.)
2. A nurse is caring for a client who has bacterial meningitis. Upon monitoring the client,
which of the following findings should the nurse expect?
a) Flaccid neck(The nurse should recognize that nuchal rigidity, rather than a flaccid neck,
is a manifestation of meningitis.)
b) Stooped posture with shuffling gait(The nurse should recognize that a stooped posture
with shuffling gait is a manifestation of Parkinson's disease, not a manifestation of
meningitis.)
c) Red macular rash(The nurse should expect to find a red macular rash, sometimes called a
petechial rash, which is a manifestation of meningococcal meningitis.)
d) Masklike facial expression(The nurse should recognize that a masklike expression is a
manifestation of Parkinson's disease, not a manifestation of meningitis.)
3. A nurse is contributing to the plan of care for an older adult client who is at risk for
osteoporosis. Which of the following interventions should the nurse include to prevent bone
loss?
a) Increase fluid intake.(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 of
developing osteoporosis. However, fluid intake does not prevent bone loss.)
b) Encourage range-of-motion exercises.(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.)
c) Massage bony prominences.(Massaging bony prominences should be avoided because it
can traumatize deep tissues.)
d) Encourage weight-bearing exercises.(Weight-bearing exercises, such as walking, can
maintain bone mass by reducing bone demineralization, thus helping to prevent
osteoporosis.)
4. A nurse is collecting data from a client and notices several skin lesion. Which of the
following findings should the nurse report as possible melanoma?
a) Scaly patches(The nurse should report scaly patches as possible basal or squamous cell
carcinoma.
b) Silvery white plaques(The nurse should report silvery white plaques as possible
psoriasis.)
, c) Irregular borders(The nurse should report irregular borders of a skin lesion to the
provider because it can indicate malignant melanoma.)
d) Raised edges(The nurse should report raised edges of a skin lesion as possible basal cell
carcinoma.)
5. A nurse is reinforcing discharge teaching to prevent dumping syndrome for a client
following a partial gastrectomy for ulcers. Which of the following information should the
nurse include in the teaching?
a) Avoid liquids at mealtimes.(The nurse should remind the client to avoid drinking liquids
at mealtimes to prevent the food from emptying into the small bowel too quickly.)
b) Exclude eating starchy vegetables.(The nurse should remind the client to include starchy
vegetables in the meal plan to slow gastric emptying.)
c) Avoid eating high-protein meals.(The nurse should remind the client to eat high-protein
meals to help slow gastric emptying.)
d) Plan to increase intake of sweetened fruits.(The nurse should remind the client to exclude
sweetened fruits from the diet to help slow gastric emptying.)
6. A nurse is collecting data on a client who is scheduled for a cardiac catheterization. Which
of the following laboratory levels should the nurse review prior to the procedure?
a) Albumin(Albumin levels determine the amount of protein the liver produces in the body
and is an indication of hepatic function and nutritional status. However, it is not impacted
by contrast media used for cardiac catheterization. Therefore, the nurse does not need to
review this laboratory level prior to a cardiac catheterization.)
b) Phosphorus(Phosphorus is an electrolyte that combines with calcium to maintain bone
health and is involved as an energy source in metabolism. However, it is not impacted by
contrast media used for cardiac catheterization. Therefore, the nurse does not need to
review this laboratory level prior to a cardiac catheterization.)
c) TSH(TSH levels determine thyroid function. However, it is not impacted by contrast
media used for cardiac catheterization. Therefore, the nurse does not need to review this
laboratory level prior to a cardiac catheterization.)
d) BUN(BUN levels indicate kidney function. Contrast media used during cardiac
catheterization can cause renal failure. The nurse should review this laboratory level to
determine if the client can tolerate the IV contrast dye during the procedure.)
7. A nurse is reinforcing glycosylated hemoglobin (HbA1c) testing with a client who has
diabetes mellitus. Which of the following statements indicates that the client understands
the teaching?
a) "The HbA1c test should be performed 2 hr after I eat a meal that is high in
carbohydrates."(The nurse should remind the client that carbohydrate consumption is not
required for HbA1c testing.)
b) "The HbA1c test can help detect the presence of ketones in my body."(The nurse should
remind the client that urine testing can detect ketone bodies.)
c) "I will have my HbA1c checked twice per year."(An HbA1c test provides the client's
average glucose level for the preceding 3 months. The nurse should instruct the client to
have her HbA1c tested twice yearly to manage her glucose.)
d) "I will plan to fast before I have my HbA1c tested."(The nurse should remind the client
that fasting is not required for HbA1C testing.)
1. A nurse is reinforcing discharge teaching about wound care with a family member of a
client who is postoperative. Which of the following should the nurse include in the teaching?
a) Administer an analgesic following wound care.(The nurse should remind the family
member to administer an analgesic prior to wound care to prevent discomfort.)
b) Irrigate the wound with povidone iodine.(The nurse should remind the family member to
irrigate the wound with 0.9% sodium chloride.)
c) Cleanse the wound with a cotton-tipped applicator.(The nurse should remind the family
member to avoid using a cotton-tipped applicator to cleanse the wound because the fibers
can become embedded in the wound, cause infection, and delay wound healing.)
d) Report purulent drainage to the provider.(The nurse should remind the family member to
report signs of infection, including purulent drainage.)
2. A nurse is caring for a client who has bacterial meningitis. Upon monitoring the client,
which of the following findings should the nurse expect?
a) Flaccid neck(The nurse should recognize that nuchal rigidity, rather than a flaccid neck,
is a manifestation of meningitis.)
b) Stooped posture with shuffling gait(The nurse should recognize that a stooped posture
with shuffling gait is a manifestation of Parkinson's disease, not a manifestation of
meningitis.)
c) Red macular rash(The nurse should expect to find a red macular rash, sometimes called a
petechial rash, which is a manifestation of meningococcal meningitis.)
d) Masklike facial expression(The nurse should recognize that a masklike expression is a
manifestation of Parkinson's disease, not a manifestation of meningitis.)
3. A nurse is contributing to the plan of care for an older adult client who is at risk for
osteoporosis. Which of the following interventions should the nurse include to prevent bone
loss?
a) Increase fluid intake.(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 of
developing osteoporosis. However, fluid intake does not prevent bone loss.)
b) Encourage range-of-motion exercises.(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.)
c) Massage bony prominences.(Massaging bony prominences should be avoided because it
can traumatize deep tissues.)
d) Encourage weight-bearing exercises.(Weight-bearing exercises, such as walking, can
maintain bone mass by reducing bone demineralization, thus helping to prevent
osteoporosis.)
4. A nurse is collecting data from a client and notices several skin lesion. Which of the
following findings should the nurse report as possible melanoma?
a) Scaly patches(The nurse should report scaly patches as possible basal or squamous cell
carcinoma.
b) Silvery white plaques(The nurse should report silvery white plaques as possible
psoriasis.)
, c) Irregular borders(The nurse should report irregular borders of a skin lesion to the
provider because it can indicate malignant melanoma.)
d) Raised edges(The nurse should report raised edges of a skin lesion as possible basal cell
carcinoma.)
5. A nurse is reinforcing discharge teaching to prevent dumping syndrome for a client
following a partial gastrectomy for ulcers. Which of the following information should the
nurse include in the teaching?
a) Avoid liquids at mealtimes.(The nurse should remind the client to avoid drinking liquids
at mealtimes to prevent the food from emptying into the small bowel too quickly.)
b) Exclude eating starchy vegetables.(The nurse should remind the client to include starchy
vegetables in the meal plan to slow gastric emptying.)
c) Avoid eating high-protein meals.(The nurse should remind the client to eat high-protein
meals to help slow gastric emptying.)
d) Plan to increase intake of sweetened fruits.(The nurse should remind the client to exclude
sweetened fruits from the diet to help slow gastric emptying.)
6. A nurse is collecting data on a client who is scheduled for a cardiac catheterization. Which
of the following laboratory levels should the nurse review prior to the procedure?
a) Albumin(Albumin levels determine the amount of protein the liver produces in the body
and is an indication of hepatic function and nutritional status. However, it is not impacted
by contrast media used for cardiac catheterization. Therefore, the nurse does not need to
review this laboratory level prior to a cardiac catheterization.)
b) Phosphorus(Phosphorus is an electrolyte that combines with calcium to maintain bone
health and is involved as an energy source in metabolism. However, it is not impacted by
contrast media used for cardiac catheterization. Therefore, the nurse does not need to
review this laboratory level prior to a cardiac catheterization.)
c) TSH(TSH levels determine thyroid function. However, it is not impacted by contrast
media used for cardiac catheterization. Therefore, the nurse does not need to review this
laboratory level prior to a cardiac catheterization.)
d) BUN(BUN levels indicate kidney function. Contrast media used during cardiac
catheterization can cause renal failure. The nurse should review this laboratory level to
determine if the client can tolerate the IV contrast dye during the procedure.)
7. A nurse is reinforcing glycosylated hemoglobin (HbA1c) testing with a client who has
diabetes mellitus. Which of the following statements indicates that the client understands
the teaching?
a) "The HbA1c test should be performed 2 hr after I eat a meal that is high in
carbohydrates."(The nurse should remind the client that carbohydrate consumption is not
required for HbA1c testing.)
b) "The HbA1c test can help detect the presence of ketones in my body."(The nurse should
remind the client that urine testing can detect ketone bodies.)
c) "I will have my HbA1c checked twice per year."(An HbA1c test provides the client's
average glucose level for the preceding 3 months. The nurse should instruct the client to
have her HbA1c tested twice yearly to manage her glucose.)
d) "I will plan to fast before I have my HbA1c tested."(The nurse should remind the client
that fasting is not required for HbA1C testing.)
