ATI - Adult Medical Surgical NGN B (2025 updated)
QUESTIONS AND ANSWERS (DETAILED &
ELABORATED) fully solved
A nurse is providing teaching to a client who is perimenopausal and has a
prescription for hormone replacement therapy. For which of the following
adverse effects should the nurse instruct the client to notify the provider? -
(ANSWER)Calf pain
Numbness in the arms
Intense headache
A nurse is planning care for a client who is postoperative following a laparotomy
and has a closed-suction drain. Which of the following actions should the nurse
take to manage the drain? - (ANSWER)Compress the drain reservoir after
emptying.
A nurse is caring for a client who has DKA. Which of the following findings should
indicate to the nurse that the client's condition is improving? - (ANSWER)Glucose
272 mg/dL
A nurse is reviewing the laboratory findings of a client who developed chest pain
6 hr ago. The nurse should identify which of the following findings as an indication
of a myocardial infarction (MI)? - (ANSWER)Troponin I 8 ng/mL
A nurse is planning a health promotional presentation for a group of African
American clients at a community center. Which of the following disorders
presents the greatest risk to this group of clients? - (ANSWER)hypertension
,A nurse is providing education to a client who is at risk for osteoporosis. Which of
the following instructions should the nurse include? - (ANSWER)Walk for 30 min
four times per week.
A nurse is caring for a client who has an arterial line. Which of the following
actions should the nurse take? - (ANSWER)Place a pressure bag around the flush
solution.
A nurse is reviewing the ABG results of a client who has advanced COPD. Which of
the following results should the nurse expect? - (ANSWER)PaCO2 56
A nurse is providing postoperative teaching for a client who had a total knee
arthroplasty. Which of the following instructions should the nurse include? -
(ANSWER)Flex the foot every hour when awake.
A nurse is planning care for a client who is postoperative following a
parathyroidectomy. Which of the following actions should the nurse identify as
the priority? - (ANSWER)Place a tracheostomy tray at the bedside.
A nurse is evaluating the plan of care for four clients after 2 days of
hospitalization. The nurse should identify the need to revise the plan for which of
the following clients? - (ANSWER)A client who is postoperative following
abdominal surgery and reports feeling that something "popped" when they
coughed
,A nurse is checking the ECG rhythm strip for a client who has a temporary
pacemaker. The nurse notes a pacemaker artifact followed by a QRS complex.
Which of the following actions should the nurse take? - (ANSWER)Document that
depolarization has occurred.
A nurse is providing discharge instructions to a client who has active tuberculosis
(TB). Which of the following information should the nurse include in the
instructions? - (ANSWER)Sputum specimens are necessary every 2 to 4 weeks
until there are three negative cultures.
A nurse is caring for a client who is receiving a blood transfusion. The client
becomes restless, dyspneic, and has crackles noted to the lung bases. Which of
the following actions should the nurse anticipate taking? - (ANSWER)Slow the
infusion rate
A nurse is assessing a client who is postoperative following a thyroidectomy.
Which of the following findings is the nurse's priority? - (ANSWER)Temperature
38.9° C (102° F)
A nurse is caring for a client who has homonymous hemianopsia as a result of a
stroke. To reduce the risk of falls when ambulating, the nurse should provide
which of the following instructions to the client? - (ANSWER)Scan the
environment by turning your head from side to side.
A PACU nurse is assessing a client who is postoperative following a right
nephrectomy. The client's initial vital signs were heart rate 80/min, blood
pressure 130/70 mm Hg, respiratory rate 16/min, and temperature 36° C (96.80
, F). Which of the following vital sign changes should alert the nurse that the client
might be hemorrhaging? - (ANSWER)Heart rate 110/min
A nurse is caring for a client who is 8 hr postoperative following a total hip
arthroplasty. The client is unable to void on the bedpan. Which of the following
actions should the nurse take first? - (ANSWER)Scan the bladder with a portable
ultrasound.
A nurse is assessing a client who has advanced lung cancer and is receiving
palliative care. The client has just undergone thoracentesis. The nurse should
expect a reduction in which of the following common manifestations of advanced
cancer? - (ANSWER)Dyspnea
A nurse is caring for a client who is postoperative. - (ANSWER)Nurses' Notes
Client admitted to medical-surgical unit from PACU. Client reports incisional pain
as 2 on a scale of 0 to 10. Client appears restless and frequently asks for water.
Bilateral lower extremities cool with +1 pedal pulses. Urine output is 40 mL for
the past 2 hr. Moderate amount of bright red drainage noted on surgical incision
dressing.
Vital Signs
Temperature 37.6° C (99.7° F)
Heart rate 114/min
Respiratory rate 22/min
Blood pressure 88/54 mm Hg
QUESTIONS AND ANSWERS (DETAILED &
ELABORATED) fully solved
A nurse is providing teaching to a client who is perimenopausal and has a
prescription for hormone replacement therapy. For which of the following
adverse effects should the nurse instruct the client to notify the provider? -
(ANSWER)Calf pain
Numbness in the arms
Intense headache
A nurse is planning care for a client who is postoperative following a laparotomy
and has a closed-suction drain. Which of the following actions should the nurse
take to manage the drain? - (ANSWER)Compress the drain reservoir after
emptying.
A nurse is caring for a client who has DKA. Which of the following findings should
indicate to the nurse that the client's condition is improving? - (ANSWER)Glucose
272 mg/dL
A nurse is reviewing the laboratory findings of a client who developed chest pain
6 hr ago. The nurse should identify which of the following findings as an indication
of a myocardial infarction (MI)? - (ANSWER)Troponin I 8 ng/mL
A nurse is planning a health promotional presentation for a group of African
American clients at a community center. Which of the following disorders
presents the greatest risk to this group of clients? - (ANSWER)hypertension
,A nurse is providing education to a client who is at risk for osteoporosis. Which of
the following instructions should the nurse include? - (ANSWER)Walk for 30 min
four times per week.
A nurse is caring for a client who has an arterial line. Which of the following
actions should the nurse take? - (ANSWER)Place a pressure bag around the flush
solution.
A nurse is reviewing the ABG results of a client who has advanced COPD. Which of
the following results should the nurse expect? - (ANSWER)PaCO2 56
A nurse is providing postoperative teaching for a client who had a total knee
arthroplasty. Which of the following instructions should the nurse include? -
(ANSWER)Flex the foot every hour when awake.
A nurse is planning care for a client who is postoperative following a
parathyroidectomy. Which of the following actions should the nurse identify as
the priority? - (ANSWER)Place a tracheostomy tray at the bedside.
A nurse is evaluating the plan of care for four clients after 2 days of
hospitalization. The nurse should identify the need to revise the plan for which of
the following clients? - (ANSWER)A client who is postoperative following
abdominal surgery and reports feeling that something "popped" when they
coughed
,A nurse is checking the ECG rhythm strip for a client who has a temporary
pacemaker. The nurse notes a pacemaker artifact followed by a QRS complex.
Which of the following actions should the nurse take? - (ANSWER)Document that
depolarization has occurred.
A nurse is providing discharge instructions to a client who has active tuberculosis
(TB). Which of the following information should the nurse include in the
instructions? - (ANSWER)Sputum specimens are necessary every 2 to 4 weeks
until there are three negative cultures.
A nurse is caring for a client who is receiving a blood transfusion. The client
becomes restless, dyspneic, and has crackles noted to the lung bases. Which of
the following actions should the nurse anticipate taking? - (ANSWER)Slow the
infusion rate
A nurse is assessing a client who is postoperative following a thyroidectomy.
Which of the following findings is the nurse's priority? - (ANSWER)Temperature
38.9° C (102° F)
A nurse is caring for a client who has homonymous hemianopsia as a result of a
stroke. To reduce the risk of falls when ambulating, the nurse should provide
which of the following instructions to the client? - (ANSWER)Scan the
environment by turning your head from side to side.
A PACU nurse is assessing a client who is postoperative following a right
nephrectomy. The client's initial vital signs were heart rate 80/min, blood
pressure 130/70 mm Hg, respiratory rate 16/min, and temperature 36° C (96.80
, F). Which of the following vital sign changes should alert the nurse that the client
might be hemorrhaging? - (ANSWER)Heart rate 110/min
A nurse is caring for a client who is 8 hr postoperative following a total hip
arthroplasty. The client is unable to void on the bedpan. Which of the following
actions should the nurse take first? - (ANSWER)Scan the bladder with a portable
ultrasound.
A nurse is assessing a client who has advanced lung cancer and is receiving
palliative care. The client has just undergone thoracentesis. The nurse should
expect a reduction in which of the following common manifestations of advanced
cancer? - (ANSWER)Dyspnea
A nurse is caring for a client who is postoperative. - (ANSWER)Nurses' Notes
Client admitted to medical-surgical unit from PACU. Client reports incisional pain
as 2 on a scale of 0 to 10. Client appears restless and frequently asks for water.
Bilateral lower extremities cool with +1 pedal pulses. Urine output is 40 mL for
the past 2 hr. Moderate amount of bright red drainage noted on surgical incision
dressing.
Vital Signs
Temperature 37.6° C (99.7° F)
Heart rate 114/min
Respiratory rate 22/min
Blood pressure 88/54 mm Hg
