ATI Comprehensive Medical Surgical Exam
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Free ATI Comprehensive Medical Surgical Exam Questions
A nurse is caring for a client who has acute respiratory distress syndrome (ARDS) and is receiving mechanical ventilation. The client is restless and has an oxygen saturation of 90%. Which of the following actions should the nurse take first
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Obtain arterial blood gases from the client.
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Document the findings in the client's medical record.
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Auscultate the client for bilateral breath sounds.
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Perform in-line suctioning for the client.
Explanation
Correct Answer C. Auscultate the client for bilateral breath sounds.
Explanation
In a client with ARDS on mechanical ventilation who becomes restless with an SpO₂ of 90%, the first priority is to assess for potential causes of hypoxia. Auscultating breath sounds helps determine whether there's mucus obstruction, atelectasis, pneumothorax, or endotracheal tube displacement, all of which can impair oxygenation. Assessment must precede intervention.
Why Other Options Are Wrong
A. Obtain arterial blood gases from the client
ABGs provide detailed oxygenation and ventilation data, but this is a diagnostic measure, not the immediate first action. Initial assessment should guide the need for ABGs.
B. Document the findings in the client's medical record
Documentation is important but not a priority action in an acute change in condition. Immediate assessment and intervention come first.
D. Perform in-line suctioning for the client
Suctioning should only be performed after confirming the presence of secretions or indications of airway obstruction via assessment (like auscultation).
A nurse is caring for a client who is postoperative following a craniotomy for a tumor removal and has a surgical drain in place. Which of the following actions should the nurse take
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Provide the client with clear liquids after 8 hr postoperative.
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Apply a warm, moist compress if the client develops periorbital edema.
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Measure the surgical drain output every 12 hr.
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Maintain the client's head in a midline, neutral position.
Explanation
Correct Answer D. Maintain the client's head in a midline, neutral position.
Explanation
Maintaining the head in a midline, neutral position promotes optimal venous drainage from the brain and helps reduce intracranial pressure (ICP), which is especially important after a craniotomy. Improper positioning can impair cerebral circulation and contribute to complications.
Why Other Options Are Wrong
A. Provide the client with clear liquids after 8 hr postoperative
The return to oral intake depends on neurological status, gag reflex, and bowel sounds, not just a timed schedule. Automatically giving fluids at 8 hours may not be safe.
B. Apply a warm, moist compress if the client develops periorbital edema
Warm compresses are not recommended in the immediate post-craniotomy phase. They can increase blood flow and exacerbate swelling. Cold compresses are more appropriate early on if needed.
C. Measure the surgical drain output every 12 hr
Surgical drain output should be monitored more frequently, typically every 1–2 hours initially, to detect signs of excessive bleeding or CSF leakage early.
A charge nurse is teaching a nurse about becoming a mentor for a small group of newly licensed nurses. Which of the following statements should the charge nurse include in the teaching
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This role eases the transition during the orientation time for a newly licensed nurse.
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This role is to provide ongoing interactive supervision for the newly licensed nurse.
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This role is to orient the newly licensed nurse to a specific nursing unit.
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This role aids in socialization for the newly licensed nurse
Explanation
Correct Answer D. This role aids in socialization for the newly licensed nurse.
Explanation
A mentor helps the newly licensed nurse with professional socialization, confidence building, and development of their nursing identity. The mentor serves as a role model and guide, often beyond the formal orientation period, supporting growth in the nursing role.
Why Other Options Are Wrong
A. This role eases the transition during the orientation time for a newly licensed nurse.
This is more descriptive of a preceptor, who helps during the initial orientation phase.
B. This role is to provide ongoing interactive supervision for the newly licensed nurse.
This describes a supervisory or management role, not that of a mentor.
C. This role is to orient the newly licensed nurse to a specific nursing unit.
That is the role of a preceptor, not a mentor. Mentors support broader professional development and integration into the nursing profession.
A nurse is obtaining a 12-lead ECG for a client who reports chest pain. The nurse should identify that which of the following findings is an indication that the client is experiencing a myocardial infarction
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The client's ventricular heart rate is 100/min.
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The client's ST segments are 2 mm above the isoelectric line.
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The client's PR interval on the ECG strip is 0.12 seconds.
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The client's QRS duration on the ECG strip is 0.08 seconds.
Explanation
Correct Answer B. The client's ST segments are 2 mm above the isoelectric line.
Explanation
ST segment elevation is a hallmark sign of acute myocardial infarction (STEMI). Elevation of 1 mm or more in at least two contiguous leads is considered significant. 2 mm of elevation is a clear indicator of myocardial injury and requires immediate intervention.
Why Other Options Are Wrong
A. The client's ventricular heart rate is 100/min
This is at the upper limit of normal and does not specifically indicate myocardial infarction.
C. The client's PR interval on the ECG strip is 0.12 seconds
This is a normal PR interval (0.12–0.20 seconds) and does not indicate myocardial infarction.
D. The client's QRS duration on the ECG strip is 0.08 seconds
This is a normal QRS duration (≤0.10 seconds), so it is not diagnostic of MI.
A school nurse is teaching high school students about the transmission of HIV. Which of the following statements by a student indicates an understanding of the teaching
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HIV cannot be transmitted through oral-genital contact.
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Wearing a latex glove during hand-genital contact can help prevent the transmission of HIV.
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It is easier for HIV to be transmitted by contact with vaginal secretions.
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People who are receiving antiretroviral therapy cannot transmit HIV.
Explanation
Correct Answer B. Wearing a latex glove during hand-genital contact can help prevent the transmission of HIV.
Explanation
Barrier protection, such as using latex gloves or condoms, reduces the risk of exposure to blood and bodily fluids, including during hand-genital contact, especially if there are cuts or open areas on the hands. Proper use of barriers is a key method for HIV prevention.
Why Other Options Are Wrong
A. HIV cannot be transmitted through oral-genital contact.
This is incorrect. While the risk is lower compared to other sexual activities, HIV can still be transmitted through oral-genital contact, especially if there are cuts or sores in the mouth or genitals.
C. It is easier for HIV to be transmitted by contact with vaginal secretions.
HIV transmission is more likely through blood and semen than vaginal secretions, although vaginal fluids can still carry the virus. The risk is lower compared to other fluids like semen or blood.
D. People who are receiving antiretroviral therapy cannot transmit HIV.
This is not entirely accurate. While antiretroviral therapy (ART) can reduce viral load to undetectable levels, which greatly lowers the risk of transmission ("undetectable = untransmittable" or U=U), it requires consistent adherence to be effective, and transmission is still possible if the viral load becomes detectable.
A nurse manager is providing an in-service on legal responsibilities for newly licensed nurses. Which of the following should the nurse manager include as an example of professional negligence
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Discussing a client's diagnosis with a nurse from a different unit
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Giving an IM medication after the client refuses it
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Refusing to allow a client to leave the facility without a provider's order
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Administering a stat medication 2 hr after the medication is prescribed
Explanation
Correct Answer D. Administering a stat medication 2 hr after the medication is prescribed
Explanation
Professional negligence occurs when a nurse fails to act in a way a reasonably prudent nurse would, resulting in harm or risk to the client. A stat medication is meant to be given immediately, typically within 30 minutes. Giving it 2 hours later is a breach of standard care and an example of negligence.
Why Other Options Are Wrong
A. Discussing a client's diagnosis with a nurse from a different unit
This is a breach of confidentiality or HIPAA violation, but not professional negligence.
B. Giving an IM medication after the client refuses it
This is battery, a form of intentional tort, not negligence.
C. Refusing to allow a client to leave the facility without a provider's order
This could be considered false imprisonment, another intentional tort, not negligence.
A nurse is caring for a client who has Cushing's disease and is starting treatment with ketoconazole. Which of the following findings should the nurse identify as an adverse effect of this medication
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Decreased magnesium level
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Liver dysfunction
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Bone marrow suppression
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Increased triglycerides
Explanation
Correct Answer B. Liver dysfunction
Explanation
Ketoconazole is an antifungal medication also used off-label to treat Cushing’s disease by inhibiting cortisol synthesis. One of its most serious and well-known adverse effects is hepatotoxicity. The nurse should monitor liver function tests (LFTs) and watch for clinical signs such as jaundice, dark urine, and right upper quadrant pain. Early detection of liver dysfunction is essential to prevent serious liver damage.
Why Other Options Are Wrong
A. Decreased magnesium level
Ketoconazole is not commonly associated with significant changes in magnesium levels. Other drugs, like certain diuretics or proton pump inhibitors, are more likely to cause this.
C. Bone marrow suppression
This is not a typical adverse effect of ketoconazole. Drugs like chemotherapy agents or some antivirals are more known for this risk.
D. Increased triglycerides
Ketoconazole does not typically elevate triglyceride levels. This is more commonly seen with corticosteroids or certain antipsychotics.
A nurse is reviewing the laboratory results of a client who has systemic lupus erythematosus. Which of the following results should the nurse expect to find
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Increased D-dimer
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Elevated brain natriuretic peptide
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Elevated erythrocyte sedimentation rate
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Positive rheumatoid factor
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Elevated troponin I
Explanation
Correct Answers
C. Elevated erythrocyte sedimentation rate
D. Positive rheumatoid factor
Explanation
C. Elevated erythrocyte sedimentation rate
ESR is a nonspecific marker of inflammation and is commonly elevated in clients with SLE due to the autoimmune inflammatory process.
D. Positive rheumatoid factor
Although typically associated with rheumatoid arthritis, rheumatoid factor can also be present in clients with SLE due to overlapping autoimmune activity.
Why Other Options Are Wrong
A. Increased D-dimer
D-dimer is associated with thrombotic events like DVT or PE, not a routine finding in SLE unless complications occur.
B. Elevated brain natriuretic peptide
BNP is a marker for heart failure and is not specific to SLE unless the disease has caused cardiac involvement.
E. Elevated troponin I
Troponin I indicates myocardial injury. It may be elevated only if SLE causes myocarditis or other cardiac damage, which is not typical in stable SLE.
A nurse is assessing a client who has a deep-vein thrombosis and experiences a sudden onset of dyspnea. The nurse should identify that which of the following findings indicates the client is experiencing a pulmonary embolism
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Xeroderma
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Hiccups
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Decreased heart rate
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Pleural friction rub
Explanation
Correct Answer D. Pleural friction rub
Explanation
A pleural friction rub is a classic sign of a pulmonary embolism (PE), especially when the embolism leads to pulmonary infarction. It results from inflammation of the pleura and occurs with pleuritic chest pain and dyspnea. The sudden onset of breathing difficulty along with this auscultatory finding strongly suggests PE in a client with DVT.
Why Other Options Are Wrong
A. Xeroderma
This refers to dry skin and is not related to pulmonary embolism. It is usually associated with dermatologic or autoimmune conditions.
B. Hiccups
Hiccups are not a typical symptom of pulmonary embolism. They may occur with gastrointestinal irritation or central nervous system issues, but not PE.
C. Decreased heart rate
Pulmonary embolism typically causes tachycardia (increased heart rate), not a decreased heart rate. The body responds to hypoxia and stress from the embolism with a sympathetic response.
A nurse is assisting with mass casualty triage for a disaster event. The nurse should tag which of the following clients to receive care first
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A client who has a traumatic, lower limb amputation
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A client who is paralyzed from a high cervical spinal cord injury
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A client who has lacerations on his arms and legs
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A client who has a closed, nondisplaced fracture of the right arm
Explanation
Correct Answer A. A client who has a traumatic, lower limb amputation
Explanation
In mass casualty triage, priority is given to those with life-threatening but survivable injuries. A traumatic lower limb amputation poses a high risk of hemorrhage, which can be rapidly fatal if not treated immediately. This client would receive a red tag (immediate priority) and should be treated first to preserve life.
Why Other Options Are Wrong
B. A client who is paralyzed from a high cervical spinal cord injury
This client likely has limited survival potential in a mass casualty setting due to compromised breathing and neurological status. They would typically be assigned an expectant (black tag).
C. A client who has lacerations on his arms and legs
These are non-life-threatening injuries and would be tagged as minor (green)—treatment can be delayed.
D. A client who has a closed, nondisplaced fracture of the right arm
This is a non-urgent injury that does not require immediate intervention. This client would also receive a green tag.
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