ATI Comprehensive Medical Surgical Exam
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Free ATI Comprehensive Medical Surgical Exam Questions
A nurse is developing a plan of care for a client who has a head injury. Which of the following interventions should the nurse include in the plan to prevent the client from experiencing an increase in intracranial pressure
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Administer stool softeners to the client as prescribed.
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Provide a distraction for the client by keeping the television on in his room.
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Complete multiple tasks at one time when providing care for the client.
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Provide oxygen therapy to maintain saturation greater than 93%.
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Minimize sources of light in the client's room.
Explanation
Correct Answers
A. Administer stool softeners to the client as prescribed.
D. Provide oxygen therapy to maintain saturation greater than 93%.
E. Minimize sources of light in the client's room.
Explanation
Stool softeners prevent straining during bowel movements, which can raise ICP. Oxygen therapy ensures adequate cerebral oxygenation, which helps prevent hypoxia-induced ICP elevation. Minimizing light reduces sensory stimulation, helping to maintain a calm environment that avoids triggering spikes in ICP.
Why Other Options Are Wrong
B. Provide a distraction for the client by keeping the television on in his room
This increases environmental stimulation, which can aggravate ICP elevation by triggering agitation or confusion in a neurologically compromised client.
C. Complete multiple tasks at one time when providing care for the client
Bundling care without allowing rest between tasks may increase ICP due to cumulative stimulation and physical stress. Spacing out activities allows for recovery periods.
A wound care nurse is teaching a group of unit nurses about the vacuum-assisted closure system for healing of a pressure ulcer. Which of the following information should the nurse include in the teaching
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Adhesive remover should be applied when changing the transparent dressing.
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The localized pressure draws the edges of the pressure ulcer together.
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Positive pressure is used with this device for healing of the pressure ulcer.
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The system dressing remains over the pressure ulcer for 15 days before changing.
Explanation
Correct Answer B. The localized pressure draws the edges of the pressure ulcer together.
Explanation
The vacuum-assisted closure (VAC) system applies negative pressure to the wound bed, which helps draw the edges of the wound together, remove excess exudate, promote blood flow, and stimulate the growth of granulation tissue—thereby accelerating the healing process of pressure ulcers.
Why Other Options Are Wrong
A. Adhesive remover should be applied when changing the transparent dressing
Adhesive remover is not routinely used with VAC dressings, as it can interfere with the seal. Removal should be done carefully by gently lifting the edges.
C. Positive pressure is used with this device for healing of the pressure ulcer
VAC therapy uses negative pressure, not positive pressure, to aid in wound healing.
D. The system dressing remains over the pressure ulcer for 15 days before changing
VAC dressings are typically changed every 48 to 72 hours, or more frequently if the wound is infected—not left in place for 15 days.
A nurse is delegating tasks for four clients. Which of the following tasks should the nurse assign to an assistive personnel
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Apply an external urinary device on a client.
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Remove a nasogastric tube from a client.
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Assist a client to choose a low-sodium diet.
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Obtain a culture from a client's wound.
Explanation
Correct Answer A. Apply an external urinary device on a client.
Explanation
Applying an external urinary device (such as a condom catheter) is within the scope of practice for assistive personnel (AP). It is a non-invasive, routine task that does not require nursing judgment.
Why Other Options Are Wrong
B. Remove a nasogastric tube from a client
This is a nursing responsibility that involves assessment and decision-making. It cannot be delegated to an AP.
C. Assist a client to choose a low-sodium diet
This task involves dietary teaching and client education, which must be performed by a nurse or a dietitian, not AP.
D. Obtain a culture from a client's wound
Collecting a wound culture is an invasive procedure and requires aseptic technique and assessment, making it inappropriate for AP delegation.
A charge nurse is assigning care for four clients. Which of the following tasks should the nurse identify as within the nursing role of the licensed practical nurse
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Provide discharge teaching for a client following an appendectomy
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Evaluate the plan of care for a client who had a stroke
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Assess a client following a right hip arthroplasty
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Administer oral medications to a client who has heart failure
Explanation
Correct Answer D. Administer oral medications to a client who has heart failure
Explanation
Licensed practical nurses (LPNs) are authorized to administer medications, including oral medications, under the supervision of a registered nurse. This is a standard, routine task well within the LPN's scope of practice and does not require advanced assessment or teaching skills.
Why Other Options Are Wrong
A. Provide discharge teaching for a client following an appendectomy
Discharge teaching involves initial instruction and evaluation, which must be completed by a registered nurse. LPNs may reinforce teaching but cannot independently initiate it.
B. Evaluate the plan of care for a client who had a stroke
Evaluating care plans and making nursing judgments about outcomes are responsibilities of the registered nurse, not the LPN.
C. Assess a client following a right hip arthroplasty
Initial and comprehensive assessments require RN-level training. While LPNs can collect data, they are not responsible for full assessments after surgical procedures.
A nurse is assessing a client who has meningitis. The nurse should identify which of the following findings as a manifestation of hydrocephalus
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Red macular rash on chest
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Myalgia
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Reports of neck stiffness
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Unable to move eyes laterally
Explanation
Correct Answer D. Unable to move eyes laterally
Explanation
In meningitis, hydrocephalus can develop due to impaired cerebrospinal fluid (CSF) drainage. This increased intracranial pressure can compress cranial nerves, particularly the sixth cranial nerve (abducens), leading to an inability to move the eyes laterally (lateral gaze palsy). This is a significant neurological finding indicating potential brainstem or nerve compression.
Why Other Options Are Wrong
A. Red macular rash on chest
This finding is more characteristic of meningococcal meningitis and indicates sepsis or vascular involvement, not hydrocephalus.
B. Myalgia
Muscle aches are nonspecific symptoms of many infections, including viral illnesses. They are not directly linked to hydrocephalus.
C. Reports of neck stiffness
This is a classic sign of meningitis itself (meningeal irritation), but it is not specific to the development of hydrocephalus.
A nurse is planning to provide wound care for a client. According to the practice guidelines, which of the following actions should the nurse take
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Irrigate noninfected wounds with sterile water
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Cleanse the wound from the inside toward the outside
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Pat the wound dry immediately after cleansing it
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Warm the irrigant in a microwave prior to cleansing the wound
Explanation
Correct Answer B. Cleanse the wound from the inside toward the outside
Explanation
The correct technique for wound cleansing is to move from the least contaminated area to the most contaminated area. This means cleaning from the center (or inside) of the wound outward toward the surrounding skin. This method reduces the risk of introducing bacteria from the surrounding skin into the wound bed and promotes proper healing.
Why Other Options Are Wrong
A. Irrigate noninfected wounds with sterile water
Sterile normal saline—not sterile water—is the preferred irrigant for noninfected wounds. It is isotonic and does not harm tissue. Sterile water can cause cell damage due to its hypotonic nature.
C. Pat the wound dry immediately after cleansing it
Wounds should generally be allowed to air dry slightly or be gently blotted if directed, but aggressive drying can disturb granulation tissue or introduce contaminants. Drying is not always appropriate, especially for wounds being treated with moist healing strategies.
D. Warm the irrigant in a microwave prior to cleansing the wound
Microwaving irrigant solutions is unsafe because it can lead to uneven heating and potential tissue burns. If warming is necessary, the solution should be placed in a warm water bath and checked for appropriate temperature
A nurse is planning research-based care for a client who has cystic fibrosis. Which of the following resources should the nurse use
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National Patient Safety Goals
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Clinical practice guidelines
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Professional standards review
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Acuity index
Explanation
Correct Answer B. Clinical practice guidelines
Explanation
Clinical practice guidelines are evidence-based recommendations that guide healthcare professionals in the care of specific conditions, such as cystic fibrosis. These guidelines incorporate the latest research and expert consensus to ensure that patients receive high-quality, effective, and consistent care tailored to their diagnosis.
Why Other Options Are Wrong
A. National Patient Safety Goals
These focus on overall patient safety initiatives (like preventing infections or falls), not on condition-specific, research-based care plans.
C. Professional standards review
This evaluates professional performance and adherence to standards, but does not offer specific, research-based clinical guidance for managing a particular illness.
D. Acuity index
An acuity index measures the level of care a patient needs, not how to treat a specific condition like cystic fibrosis using research-based protocols.
A nurse is developing a plan of care for a client who has increased intracranial pressure (ICP) from a traumatic brain injury and is receiving mechanical ventilation. Which of the following interventions should the nurse include in the plan
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Position the client to maintain hip flexion.
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Administer an enema if the client develops constipation.
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Provide 100% oxygen to the client prior to suctioning.
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Ensure that the PEEP level is set at 20 cm of H2O.
Explanation
Correct Answer C. Provide 100% oxygen to the client prior to suctioning.
Explanation
Pre-oxygenating with 100% oxygen before suctioning is essential to prevent hypoxia, which can increase ICP. Hypoxia causes cerebral vasodilation, further raising intracranial pressure. This step is a standard precaution in clients with elevated ICP.
Why Other Options Are Wrong
A. Position the client to maintain hip flexion.
Hip flexion increases intra-abdominal and thoracic pressure, which can impair venous return from the brain and raise ICP. The hips should be kept in a neutral or slightly extended position.
B. Administer an enema if the client develops constipation.
Enemas can increase intrathoracic pressure through straining and bearing down (Valsalva maneuver), which may elevate ICP. Stool softeners are safer alternatives.
D. Ensure that the PEEP level is set at 20 cm of H2O.
A PEEP of 20 cm H₂O is too high and can impair venous return from the brain, increasing ICP. Lower PEEP settings are typically preferred in clients with elevated ICP unless required for oxygenation.
A nurse is teaching ethical decision-making to a group of newly licensed nurses. Which of the following actions should the nurse identify as the first step in ethical behavior
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Identify the laws or facility policies that apply to the situation.
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Use interdisciplinary resources to resolve the situation.
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Clarify personal values regarding the situation.
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Evaluate the risks associated with alternative actions.
Explanation
Correct Answer C. Clarify personal values regarding the situation.
Explanation
The first step in ethical decision-making is to clarify personal values. Understanding one's own beliefs, values, and biases helps the nurse recognize how they may influence perception and judgment in ethically challenging situations. This self-awareness is essential before applying ethical principles or external policies.
Why Other Options Are Wrong
A. Identify the laws or facility policies that apply to the situation
This is an important step but comes after clarifying personal values, as policies and laws are applied during the analysis phase.
B. Use interdisciplinary resources to resolve the situation
This occurs after identifying and analyzing the ethical issue, not at the beginning of the process.
D. Evaluate the risks associated with alternative actions
This step is part of the later decision-making process, once options have been identified and analyzed.
A nurse is reviewing the medical record of a client who has heart failure and is experiencing fluid volume excess without an electrolyte imbalance. Which of the following findings should the nurse expect
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Increased urine specific gravity
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Polyuria
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Pericardial friction rub
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Distended neck veins
Explanation
Correct Answer D. Distended neck veins
Explanation
Distended neck veins (jugular venous distention) are a classic sign of fluid volume excess in a client with heart failure. This occurs due to elevated central venous pressure from impaired cardiac output, leading to venous congestion. It is a visible and reliable indicator of volume overload in this setting.
Why Other Options Are Wrong
A. Increased urine specific gravity
This usually indicates concentrated urine from dehydration or low fluid volume, not fluid volume excess. In fluid overload, the urine may be more dilute.
B. Polyuria
While some heart failure treatments (like diuretics) can cause increased urine output, polyuria is not an expected symptom of fluid volume excess itself. In untreated heart failure with excess fluid, urine output may be decreased due to poor renal perfusion.
C. Pericardial friction rub
This is typically associated with pericarditis, not fluid volume excess. It indicates inflammation of the pericardial sac, not a volume issue due to heart failure.
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