ATI Comprehensive Medical Surgical Exam
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Free ATI Comprehensive Medical Surgical Exam Questions
A nurse is assessing a client who is 16 hr postoperative following a craniotomy for a brain tumor. Which of the following findings should the nurse report to the provider immediately
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Periorbital ecchymosis
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Urinary output of 280 mL over the past 8 hr
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Rapid pupil reaction to light
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Incisional drain output of 75 mL over the past 4 hr
Explanation
Correct Answer A. Periorbital ecchymosis
Explanation
Periorbital ecchymosis following a craniotomy can indicate a basilar skull fracture or intracranial bleeding, both of which are serious complications. Although some swelling or bruising can occur from surgical manipulation, the sudden appearance or progression of bruising around the eyes—especially in the early postoperative period—requires immediate medical attention to rule out a cerebrospinal fluid (CSF) leak or intracranial hemorrhage.
Why Other Options Are Wrong
B. Urinary output of 280 mL over the past 8 hr
This value is slightly below expected output but not uncommon in the early postoperative period. It does not immediately indicate kidney failure or fluid imbalance unless it persists or worsens.
C. Rapid pupil reaction to light
This is a normal neurological finding and indicates intact cranial nerve III function. It is not concerning and does not require reporting.
D. Incisional drain output of 75 mL over the past 4 hr
This is within the expected range for post-craniotomy drainage. It becomes a concern if the drainage is excessive, suddenly increases, or changes in appearance.
A nurse manager is teaching about the concept of caring within the practice of nursing to a group of newly licensed nurses. The nurse should use which of the following examples to demonstrate this concept
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Holding a client's hand after administering a pain medication
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Documenting administration of a medication after it is given
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Checking two client identifiers prior to administering a medication
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Looking up an unfamiliar medication prior to administering it
Explanation
Correct Answer A. Holding a client's hand after administering a pain medication
Explanation
Caring in nursing encompasses emotional presence, compassion, and support beyond technical tasks. Holding a client’s hand demonstrates empathy and emotional reassurance, reinforcing the human connection and therapeutic relationship—core elements of the caring concept in nursing.
Why Other Options Are Wrong
B. Documenting administration of a medication after it is given
This reflects professional responsibility and accurate record-keeping, which are essential for safety and communication but do not directly illustrate the concept of caring.
C. Checking two client identifiers prior to administering a medication
This action represents safe medication practices and adherence to protocol, not necessarily the emotional or relational aspects that define caring.
D. Looking up an unfamiliar medication prior to administering it
This demonstrates responsible practice and commitment to safe care but relates to knowledge and safety, not the relational or emotional support defined by caring in nursing.
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 charge nurse is teaching a group of newly licensed nurses about mandatory reporting of infectious diseases. Which of the following diseases should the nurse include as an example of a nationally notifiable infectious disease
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Clostridium difficile
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Herpes simplex
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Pediculosis
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Measles
Explanation
Correct Answer D. Measles
Explanation
Measles is a nationally notifiable infectious disease, which means health care providers are legally required to report confirmed cases to public health authorities. Measles is highly contagious and can lead to serious complications, so public health monitoring and outbreak prevention are essential.
Why Other Options Are Wrong
A. Clostridium difficile
While C. difficile is a significant healthcare-associated infection and reportable within facilities, it is not nationally notifiable to the CDC in all states.
B. Herpes simplex
Herpes simplex virus (HSV) is not a reportable condition at the national level, although it may be monitored in certain public health studies.
C. Pediculosis
Pediculosis (head lice) is not a nationally notifiable disease. It is managed at the local level and not considered a major public health threat
A nurse manager is working to resolve a conflict between two staff nurses. Which of the following resolutions represents the conflict management strategy of compromise
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Both nurses agree to work together to establish a common goal.
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Both nurses are willing to give up something they would like to have.
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One nurse pursues what he wants at the expense of the other nurse.
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One nurse is willing to sacrifice what he wants so the other nurse wins.
Explanation
Correct Answer B. Both nurses are willing to give up something they would like to have.
Explanation
Compromise is a conflict resolution strategy where each party gives up something to reach a mutually acceptable solution. It helps balance power and maintain working relationships when both parties are partially satisfied with the outcome.
Why Other Options Are Wrong
A. Both nurses agree to work together to establish a common goal
This describes collaboration, not compromise. Collaboration seeks a win-win solution where neither party gives something up.
C. One nurse pursues what he wants at the expense of the other nurse
This is an example of competition, where one person wins and the other loses.
D. One nurse is willing to sacrifice what he wants so the other nurse wins
This is accommodation, where one person gives in to the other, often to preserve harmony or avoid conflict.
A nurse is caring for a client who has developed sinus bradycardia following a myocardial infarction. Which of the following medications should the nurse plan to administer
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Digoxin
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Propranolol
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Atropine
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Adenosine
Explanation
Correct Answer C. Atropine
Explanation
Atropine is the first-line medication used to treat symptomatic sinus bradycardia. It works by blocking the vagus nerve's effect on the heart, increasing the heart rate. In clients with bradycardia following a myocardial infarction, prompt administration of atropine can help restore adequate cardiac output.
Why Other Options Are Wrong
A. Digoxin
Digoxin slows the heart rate and increases cardiac contractility. It is contraindicated in bradycardia, as it could worsen the condition.
B. Propranolol
Propranolol is a beta-blocker that further decreases the heart rate and is not appropriate in cases of bradycardia.
D. Adenosine
Adenosine is used to treat supraventricular tachycardia (SVT), not bradycardia. It temporarily slows conduction through the AV node and would worsen a slow heart rate.
A nurse observes another nurse frequently removing narcotics from a client's medication drawer and disappearing several times throughout a shift. Which of the following actions should the nurse take
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Ask the client if she is receiving her pain medication.
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Assume care of the nurse's clients.
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Report the nurse's behavior to a charge nurse.
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Confront the nurse about the situation.
Explanation
Correct Answer C. Report the nurse's behavior to a charge nurse.
Explanation
When suspecting drug diversion or impairment, the observing nurse must follow the chain of command and report the suspicious behavior immediately to the charge nurse or nurse manager. This ensures that the situation is addressed appropriately, maintains patient safety, and allows for timely investigation and intervention according to facility policy and regulatory standards.
Why Other Options Are Wrong
A. Ask the client if she is receiving her pain medication
This may provide some insight but does not address the potential safety and legal concern. It also may not stop further misuse or protect other patients.
B. Assume care of the nurse's clients
Taking over care does not solve the root issue or ensure proper documentation and accountability. It also avoids required reporting protocols.
D. Confront the nurse about the situation
Direct confrontation is inappropriate and unsafe in this situation. It may escalate the issue or lead to defensiveness or concealment without resolution.
A nurse on a medical unit realizes she administered an incorrect dose of medication to a client. Which of the following ethical principles is the nurse exhibiting by completing an incident report of the event
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Responsibility
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Authority
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Accountability
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Confidentiality
Explanation
Correct Answer C. Accountability
Explanation
By completing an incident report after making a medication error, the nurse is demonstrating accountability, which involves acknowledging and accepting responsibility for actions and their outcomes. It reflects ethical and professional conduct to ensure patient safety and system improvement.
Why Other Options Are Wrong
A. Responsibility
Responsibility refers to the duty to perform tasks and obligations as part of one’s role, but it doesn’t specifically address owning up to an error.
B. Authority
Authority is related to having the power or right to make decisions, which is not the focus in this situation.
D. Confidentiality
Confidentiality refers to protecting private patient information, not the reporting of errors or adverse events.
A charge nurse is supervising a newly licensed nurse who is changing an ostomy appliance for a client. The charge nurse should intervene for which of the following actions by the newly licensed nurse
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Cuts an opening in the skin barrier 0.32 cm (0.125 in) larger than the stoma
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Applies a piece of gauze over the stoma after removing the old appliance
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Cleanses the client's skin around the stoma with deodorant soap
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Uses toilet tissue to remove stool from the client's skin around the stoma
Explanation
Correct Answer C. Cleanses the client's skin around the stoma with deodorant soap.
Explanation
Deodorant soaps contain oils, perfumes, or harsh ingredients that can irritate the skin or interfere with the adhesive on the new ostomy appliance. The peristomal skin should be cleansed using mild soap and water or just water to maintain skin integrity and promote effective sealing.
Why Other Options Are Wrong
A. Cuts an opening in the skin barrier 0.32 cm (0.125 in) larger than the stoma
This is correct technique. The opening should be about 1/8 inch (0.32 cm) larger than the stoma to allow for movement and prevent constriction.
B. Applies a piece of gauze over the stoma after removing the old appliance
This is appropriate. Gauze helps absorb any drainage while preparing the new appliance, keeping the area clean and dry.
D. Uses toilet tissue to remove stool from the client's skin around the stoma
This is acceptable. Toilet tissue can be used to wipe away stool before cleansing the skin more thoroughly.
A nurse is caring for a client who has Cushing's disease. The nurse should identify that which of the following assessments is the priority
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Monitor the client's sodium level.
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Check the client's pressure areas for skin breakdown.
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Auscultate the client's lungs for crackles.
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Check the client's weight.
Explanation
Correct Answer C. Auscultate the client's lungs for crackles.
Explanation
In clients with Cushing’s disease, fluid retention and sodium retention can lead to pulmonary edema or heart failure, making crackles in the lungs a potential life-threatening complication. Auscultating the lungs for crackles helps identify early signs of fluid overload, which requires immediate intervention to prevent respiratory compromise.
Why Other Options Are Wrong
A. Monitor the client's sodium level
Hypertension and sodium retention are common in Cushing’s, but monitoring sodium is not as urgent as identifying signs of fluid overload affecting respiratory status.
B. Check the client's pressure areas for skin breakdown
Skin integrity is important in Cushing’s due to thinning skin, but this is a lower priority compared to assessing for respiratory compromise.
D. Check the client's weight
Daily weights help monitor fluid retention, but lung assessment takes precedence, especially if fluid is shifting into the lungs and impairing gas exchange.
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