ATI PN Medical Surgical
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Free ATI PN Medical Surgical Questions
A nurse working the night shift is caring for an older adult client who has dementia and is at risk for falls. Which of the following actions should the nurse take?
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Apply a motion sensor mat to the client's bed.
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Move the overbed table away from the bed.
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Raise all four side rails while the client is in bed.
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Leave the television on in the client's room.
Explanation
Explanation
Clients who have dementia often attempt to get out of bed without calling for assistance. A motion sensor mat alerts staff as soon as the client tries to stand or move, allowing rapid intervention to prevent a fall. This is a non-restrictive, safety-enhancing strategy appropriate for nighttime when supervision is reduced. Early detection of movement is essential to maintaining safety in clients with cognitive impairment.Correct Answer Is:
A. Apply a motion sensor mat to the client's bed.A nurse is caring for a client who has a prescription for propranolol for the treatment of atrial fibrillation. Which of the following actions should the nurse take?
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Request a dosage increase if the apical heart rate is less than 60/min.
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Withhold the medication if the systolic blood pressure is less than 90 mm Hg.
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Administer the medication with an antacid.
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Instruct the client to expect increased hair growth.
Explanation
Explanation
Propranolol, a beta-blocker, lowers heart rate and blood pressure. The nurse should hold the medication if the systolic BP is less than 90 mm Hg because giving it could cause severe hypotension. The medication should also be withheld if the apical pulse is less than 60/min, not increased as in option A. Antacids can interfere with absorption, so option C is incorrect. Propranolol does not cause increased hair growth.Correct Answer Is:
B. Withhold the medication if the systolic blood pressure is less than 90 mm Hg.A nurse is collecting data from a client who has hyperthyroidism and is taking propylthiouracil. Which of the following statements by the client indicates the medication is effective?
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"I no longer feel nervous."
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"I no longer take a stool softener."
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"I have less oily skin."
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"I continue to lose weight."
Explanation
Explanation
Propylthiouracil works by reducing excessive thyroid hormone production, which decreases the metabolic overstimulation characteristic of hyperthyroidism. Symptoms such as nervousness, anxiety, and irritability typically improve as thyroid levels return toward normal. A reduction in nervousness is a clear sign that the medication is effectively controlling hypermetabolism. Continued weight loss or persistent symptoms would indicate inadequate treatment, while bowel changes and oily skin are less direct indicators of therapeutic response.Correct Answer Is:
a) "I no longer feel nervous."A nurse is caring for a client who is taking lithium and reports persistent nausea and vomiting for 2 days. Which of the following laboratory values should the nurse report to the provider?
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Potassium 4.0 mEq/L
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Lithium 0.9 mEq/L
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BUN 12 mg/dL
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Sodium 132 mEq/L
Explanation
Explanation
Lithium levels are highly sensitive to sodium balance. A sodium level of 132 mEq/L indicates hyponatremia, which increases renal reabsorption of lithium and places the client at serious risk for lithium toxicity. Persistent nausea and vomiting already suggest fluid and electrolyte loss, which further heightens this risk. Prompt reporting is essential so the provider can address the sodium imbalance and prevent life-threatening lithium accumulation.Correct Answer Is:
D. Sodium 132 mEq/LA nurse is reviewing a client's medical record. Which of the following findings is the priority for the nurse to report?
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Urine output 200 mL/8 hrs
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A client's rating of ear pain as 5 on a scale from 0 to 10
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Potassium level 6.2 mEq/L
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Abnormal hepatoiminodiacetic acid (HIDA) scan
Explanation
Explanation
A potassium level of 6.2 mEq/L indicates severe hyperkalemia, a life-threatening electrolyte imbalance that can cause fatal cardiac dysrhythmias such as ventricular fibrillation or asystole. This finding requires immediate intervention, including cardiac monitoring and medications to stabilize the myocardium and shift potassium intracellularly. Because hyperkalemia poses an immediate threat to life, it takes priority over pain, low urine output, or an abnormal diagnostic scan.Correct Answer Is:
c) Potassium level 6.2 mEq/LA nurse is caring for a client who is receiving treatment for cancer and is experiencing stomatitis. Which of the following actions should the nurse take to help manage the condition?
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Discourage drinking with a straw.
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Recommend consumption of cold items.
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Provide an alcohol-based mouthwash.
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Minimize the use of gravies and sauces.
Explanation
Explanation
Stomatitis causes painful inflammation of the oral mucosa, making eating and drinking uncomfortable. Cold foods and beverages help soothe inflamed tissues by providing a numbing effect and reducing irritation. This can increase comfort and promote adequate nutritional intake during cancer treatment. Soft, cool foods such as ice chips, popsicles, and chilled drinks are commonly recommended to relieve discomfort and support hydration while minimizing trauma to the sensitive oral mucosa.Correct Answer Is:
B. Recommend consumption of cold items.A nurse is reinforcing teaching with a client who has ovarian cancer and will receive chemotherapy through a peripherally inserted central catheter (PICC) line. Which of the following statements by the client indicates an understanding of the teaching?
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"I will wear an arm immobilizer to prevent dislodgement of this device."
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"I will monitor my temperature for fever while I have this device."
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"It's okay to get the device wet when I shower."
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"I should pull the dressing away from the insertion site when I change it."
Explanation
Explanation
Clients with PICC lines are at risk for central line–associated bloodstream infections (CLABSIs). Monitoring temperature daily allows early detection of infection, which is especially important for immunocompromised clients receiving chemotherapy. This statement shows correct understanding of PICC line care. The device should not get wet, dressings must be removed gently and sterilely, and arm immobilizers are not required and increase clotting risk.Correct Answer Is:
b) "I will monitor my temperature for fever while I have this device."A nurse is reinforcing teaching with a client about increasing her intake of fiber. Which of the following foods should the nurse encourage the client to eat?
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Cheese
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Eggs
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Yogurt
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Pears
Explanation
Explanation
Pears are naturally high in dietary fiber, especially when the skin is consumed. Fiber promotes healthy digestion, prevents constipation, and supports bowel regularity. Encouraging clients to add fruits like pears to their diet is an effective way to increase daily fiber intake and improve gastrointestinal health.Correct Answer Is:
D. PearsA nurse is caring for a client who has diabetic neuropathy of the lower extremities and has a new prescription for a heating pad. The prescription reads, "Apply to the left foot for 20 min." Which of the following actions should the nurse take?
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Complete Semmes-Weinstein monofilament testing following treatment.
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Apply the heating pad as prescribed by the provider.
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Clarify the prescription with the provider.
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Observe the skin 10 min after the start of treatment.
Explanation
Explanation
Clients with diabetic neuropathy have decreased sensation and a significantly increased risk of burns when heat is applied to their feet. Heating pads are contraindicated because the client may not perceive excessive heat or pain, leading to severe injury. Before performing any harmful intervention, the nurse must clarify the order to ensure client safety. This action aligns with safe practice and protects the client from preventable complications.Correct Answer Is:
c) Clarify the prescription with the provider.A nurse is reinforcing teaching about home safety measures with a client who is visually impaired. Which of the following instructions should the nurse include?
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Mark the edges of steps.
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Use low-wattage light bulbs.
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Place throw rugs over electrical cords.
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Leave doors slightly ajar.
Explanation
Explanation
Clients with visual impairments rely heavily on high-contrast visual cues to navigate safely. Marking the edges of steps—using brightly colored or reflective tape—helps the client distinguish depth changes, reducing the risk of falls. This intervention enhances environmental visibility and supports independent mobility. Low-wattage bulbs decrease visibility and increase fall risk, while throw rugs are a major tripping hazard even when used to cover cords. Leaving doors ajar creates unpredictable obstacles. Only marking the edges of steps provides a clear, effective safety adaptation for visual impairment.Correct Answer Is:
A. Mark the edges of steps.How to Order
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