(2024-2025) ATI Med Surg Proctored Retake Exam With NGN Questions and Verified Answers

ATI Med Surg Proctored Retake Exam (2024/2025) With NGN Questions and Verified Rationalized Answers, 100% Graded A+ Guarantee With 90 multiple choices questions and answers 1. Seizures and Epilepsy: Seizure precautions (62): During a seizure: Position client on the floor and provide a patent airway, turn client to side and loosen restrictive clothing 2. Cancer treatment options: Protective Isolation (999): If WBC drops below 1,000, place the client in a private room and initiate neutropenic precautions. - Have client remain in his room unless be needs to leave for a diagnostic procedure, in case of transport place a mask on him - Protect from possible sources of infection (plants, change water in equipment daily) - Have client, staff and visitors perform frequent hand hygiene, restrict ill visitors - Avoid invasive procedures (rectal temps, injections) - Administer (neupogen, neulasta) to stimulate WBC production 3. Infection control: Appropriate room assignment: Standard Precautions: 1. applies to all patients 2. Hand washing a. alcohol based preferred unless hands visually soiled 3. Gloves - when touching anything that has the potential to contaminate. 4. Masks, eye protection & face shields when care may cause splashing or spraying of body fluids 1 / 31 Droplet: 1. private room or with someone with same illness 2. masks Airborne: 1. private room 2. masks or respiratory protection devices a. use an N95 respirator for tuberculosis 3. Negative pressure airflow 4. full face protection if splashing or spraying is possible Contact: 1. private room or room with same illness 2. gloves & gowns 3. disposal of infections dressing materials into a single, nonporous bag without touching the outside of the bag 4. TB: Priority action for a client in the emergency department (249): -Wear an N95 or HEPA respirator -Place client in negative airflow room and implement airborne precautions -use barrier protection when the risk of hand or clothing contamination exists 2 / 31 5. Immunizations: Recommended vaccinations for older adult clients (943): Adults age 50 or older: -Pneumococcal Vaccine (PPSV) - Influenza vaccine - Herpes Zoster Vaccine -Hepatitis A - Hepatitis B - Meningococcal Vaccine 6. Pulmonary Embolism: Risk factors for DVT (258): -Long term immobility - Oral contraceptives - Pregnancy - Tobacco use - Hypercoagulabilty - Obesity - Surgery - Heart failure or chronic A-Fib - Autoimmune hemolytic anemia (sickle cell) -Long bone fractures -Advanced age 7. Disorders of the male reproductive system: Complications of continuous irrigation following Trans-urethral Resection (743): -Urethral trauma -Urinary retention - Bleeding - Infection 3 / 31 8. Stroke: Caring for a client who has left sided hemiplegia (155): - Observe extremities for injury - Apply an arm sling if client is unable to care for the affected extremity - Ensure foot rest is on wheel chair and ankle brace is on the affected foot - Instruct client to dress the affected side first 9. Fractures and immobilization devices: Prevent complications (787): -Assess neurovascular status of the affected body part for every hour for 24 hours and Q4 hours after that - Maintain body alignment - avoid lifting or removing weights -Monitor pain level - Monitor for signs of infection - Support nutrition 10. Pain Management: use of non pharmacological methods of pain relief: Cutaneous (skin) stimulation- TENS, heat, cold, therapeutic touch and massage 4 / 31 - Distraction (deep breathing, ambulation, visitors, TV and music) - Relaxation (meditation, yoga and progressive muscle relaxation -Imagery (focus on pleasant thoughts) - Elevation of extremities to promote venous return 11. Acute Kidney injury and chronic kidney disease: Evaluating teaching about nutrition: -Restrict dietary intake of potassium, phosphate and magnesium during oliguric phase -K and Na is regulated according to stage of kidney injury - high protein diet to replace the high rate of protein breakdown due to the stress from the illness. Possible TPN 12. Heart failure and pulmonary edema: Dietary teaching about sodium restric- tion: Maintain fluid and sodium restriction Increase dietary intake of potassium 13. Pulmonary Embolism: Planning care for a client who is receiving enoxa- parin: Assess for contraindications (active bleeding, peptic ulcer disease, history of stroke, recent trauma) -Monitor bleeding times (PT, aPTT and INR) -Monitor for side effects such as thrombocytopenia, anemia and hemmorhage 14. Rheumatoid Arthritis: Reviewing Laboratory Values: -Positive Anti- cyclic citrullinated peptide -RF Antibody (Diagnostic level for RA is 1:40-1:60) expected reference range 1:20 - Elevated ESR 20-40 mild inflammation 40-70 moderate 5 / 31 70-150 severe - Positive C-reactive protein - Positive ANA titier - Elevated WBC's 15. Medications affecting coagulation: Heparin Contraindications: Avoid NSAIDS while on heparin 16. Antibiotics affecting protein synthesis: Adverse effects of gentamicin: -Ototoxicity: cochlear damage (hearing loss) and vestibular damage (loss of bal- ance). -Nephrotoxicity (proteinuria, elevated BUN, creatinine levels). -Hypersensitivity ( rash, pruritis, parathesia of hands and feet, and urticaria). 17. Electrolyte imbalance: manifestations of hypokalemia: Weak, irregular pulse, hypotension, respiratory distress 6 / 31 Premature ventricular contractions, bradycardia, inverted T waves, ST depression Decreased GI motility, abdominal distension, constipation, n/v, anorexia, polyuria Decreased K (<3.5) ABG: Metabolic alkalosis (pH > 7.45) 18. Electrolyte imbalance: Priority assessment for hypokalemia: Assessing for a patent and open airway 19. Blood and blood product transfusions: Administering Fresh Frozen Plas- ma: Initiate a large bore IV access: 20 gauge needle Complete transfusion withing 2-4 hours time frame If reaction occurs: -Stop transfusion immediately - Initiate 0.9% NaCl in a separate line - Save blood bag and blood tubing 20. Cardiovascular Diagnostic and Therapeutic Procedures: Caring for a client who has a PICC: -Assessing site every 8 hours. Note redness, swelling, drainage, tenderness and condition of dressing -Change tube and positive pressure cap per facility protocol -Using 10mL or larger syringe to flush the line -Cleanse with alcohol for 3 seconds before accessing it -Use transparent dressing 21. Cardiovascular Diagnostic and Therapeutic Procedures: Teaching about a PICC: Advise client not to immerse arm in water, to cover dressing site to avoid water exposure -Avoid BP in the arm with PICC 7 / 31 22. Cardiovascular Diagnostic and Therapeutic Procedures: PICC care: - Apply an initial dressing of gauze and replace with transparent dressing within 24 hours - An initial x-ray should be taken to ensure proper placement 23. Cardiovascular and Hematologic Disorders: teaching client about food interaction with Warfarin: -Kale, spinach -Brussels sprouts -collard greens, mustard greens -green tea -grapefruit juice, alcohol 24. Angina and MI: Client teaching about nitroglycerin: Nitrogylcerin prevents coronary artery vasospasm and reduces preload and afterload. Used to treat angina and help with BP. 8 / 31 - Place nitro under tongue to dissolve - Take up to two more doses of nitro at 5-min intervals - Stop activity and rest Headache is a common side effect Orthostatic hypotension 25. Osteoporosis:Teaching about self administration of Alendronate: Take with 8oz water in the early morning before eating Remain upright for 30 minutes after taking medication 26. Diabetes Mellitus Management: teaching about self administration of in- sulin: Rotate injection sites - Inject at a 90 degree angle. Aspiration is not necessary - Advise client to eat at regular intervals, avoid alcohol intake and adjust insulin to exercise and diet to avoid hypoglycemia - When mixing insulin's, draw up the shorter acting insulin into the syringe first and then the longer acting insulin. 27. IV therapy: Performing Venipuncture on an older adult client: a 22-24 gauge catheter is best to use on older adults Tie the tourniquet sparingly and try to avoid veins in the hand 28. Dosage calculations: Calculating IV infusion rate: Ex: nurse is preparing to administer dextrose 5% in water 500 mL IV to infuse over 4 hours. The nurse should set the IV infusion pump to deliver how many mL/hr> -Volume (mL)/Time (hr) = X -500 mL/5hr = 125 mL/hr 29. IV therapy: Medication administration: Know 9 / 31 -Right Patient -Right drug -Right Dose -Right Time -Right Route 30. Arthoplasty: Pain control: Analgesics - opiods (epidural, PCA, IV, Oral) NSAIDS Continuous peripheral nerve block Ice or cold therapy to reduce swelling Head of bed slightly elevated and the affected leg in a neutral position. place a pillow or abduction device between the legs when turning to the unaffectedNe side 31. Pain management: PCA: Small frequent dosing ensure consistent plasma lev- els Morphine and Dilaudid 10 / 31 Let nurse know if the pump doesn't control the pain Client is the only person to push the button 32. Pain management: Interventions to promote postoperative recovery: Man- aging acute severe pain with short term around the clock administration of opiods parental route is best for immediate short term relief 33. GI therapeutic procedures: D/C TPN therapy: Never abruptly stop TPN, grad- ually decrease (10%) to allow body adjustment. Monitor vital signs q 4-8 hours 34. GI therapeutic procedures: Shortage of TPN Solution: Clients receiving TPN frequently need supplemental regular insulin. Keep dextrose 10% in water at the bedside in case the solution runs out. this minimizes the risk of hypoglycemia 35. Nutrition Assessment: Caring for a client with pancreatitis: -increased serum glucose -reduce pancreatic stimulation through NPO; NG tube is inserted to suction gastric contents -snacks high in calories in order to maintain weight 36. ECG and Dysrthymia monitoring: Analyzing ECG: Watch for manifestations of dysrhythmias (chest pain, decreased LOC, SOB) and hypoxia. Remove leads, print ECG report and notify the provider 37. ECG and Dysrthymia monitoring: Performing 12 lead ECG: Prepare client for 12 lead if prescribed - Position client in supine position with chest exposed - wash skin to remove oils - Attach one electrode to each of the clients extremities by applying electrodes to flat 11 / 31 surfaces above the wrist and ankles and the other 6 electrodes to the chest, avoiding chest hair. Instruct client to remain still 38. Neurologic Diagnostic Procedures: Preparing for a lumbar puncture: -In- struct client to void before procedure and have them stretch over an overbed table if sitting is preferred - Monitor the puncture site for several hours to ensure the site clots and to decrease the risk of post lumbar puncture headaches 39. COPD: Expected ABG results: Hypoxemia (decreased PaO2, less than 80) Hypercarbia (increased PaO2, greater than 45) Respiratory acidosis, metabolic alkalosis compensation 12 / 31 40. Hematologic Diagnostic Procedures: Laboratory findings to report: RBC: 4.2-5.4 and 4.7-6.1 WBC: 5-10,000 Platelets: 150-400,000 Hgb: 12-16 and 14-18 Hct: 37-47% and 42-52% PT: 11-12.5 sec aPPT: 1.5-2 times normal range of 30-40 INR: 2-3 on warfarin 41. Acid base imbalance: Interpreting ABG results: 1) Look at pH <7.35 acidosis >7.45 Alkalosis 2) PaCo2 and HCO3 <35 or >45 PaCO2 is respiratory <22 or >26 is metabolic 42. Diabetes Mellitus Management: Evaluating Glycemic Control: Monitor with HbA1c expected reference range is 4-6% acceptable target for clients with diabetes 6.5-8% indicator of average blood glucose for the past 120 days 43. Electrolyte Imabalances: Increasing the risk for digoxin toxicity: Hypokalemia and client receiving digoxin increases the risk for digoxin toxicity 44. Respiratory Diagnostic Procedures: Client positioning for thoracentesis: - Position the client sitting upright with his arms and shoulders raised and supported on pillows 13 / 31 and/or on an overbed table and with his feet and legs well supported 45. Hepatitis and Cirrhosis: Client positioning following a biopsy: Assist the client into a supine position with the upper right quadrant of the abdomen exposed 46. Cushing Disease/ Syndrome: Priority Actions: Daily weights Monitor I&O assess for hypervolemia monitor for skin breakdown 47. Fractures and Immobilization devices: Assessing for complications (795): Fat embolism: Dyspnea, chest pain and decreased oxygen saturation Decreased mental acuity Respiratory distress Tachycardia 14 / 31 Tachypnea Fever Osteomyelitis: Constant bone pain Edema Fever Possible elevated sedimentation rate 48. Gastrointestinal Therapeutic Procedures: Ostomy complications: Necro- sis: pale pink or bluish/purple in color intestinal obstruction: abdominal pain, absent bowel sounds, distention, n/v 49. Burns: Priority action during resuscitation phase: Maintain airway and ven- tilation rapid fluid resuscitation (0.9% NaCl or LR's) 50. Inflammatory Disorders: Assessing a client who has a friction rub: Assess lung sounds in all fields Friction rub occurs from -Pericarditis -Myocarditis -Rheumatic endocarditis 51. Diabetes mellitus management: Recognizing Hypoglycemia: Confusion Shaking (tremors) Hunger Diaphoresis Tachycardia 15 / 31 52. Meningitis: Assessing for client findings: - Constant Headache -Stiff neck - Photophobia - Fever and chills - Nausea and vomiting - Altered LOC - Positive Kernigs and Brudzinski's signs 53. Peripheral Vascular Diseases: Arterial Revascularization: used for severe claudication and or limb pain at rest - maintain adequate circulation - check pedal and dorsalis pulse -Note color, temperature, sensation and cap refill 16 / 31 54. Diagnostic and therapeutic procedures for female reproductive disorders: Discharge teaching for abdominal hysterectomy: well balanced diet (high in protein) Hormonal therapy restrict activity for as long as 6 weeks avoid use of tampons look for foul smelling drainage and temp > 100F 55. Arthroplasty: Preventing complications following hip arthoplasty: Follow position restrictions to avoid dislocation - use elevated seating - straight chairs with arms - abduction pillow or a pillow between client legs - externally rotate toes 56. Cancer disorders: client teaching following partial glossectomy: -Client need for alternate communication following surgery -head of bed elevated to reduce edema -report leakage of fluid from the suture line or swallowing difficulty -thicken liquids -frequent oral hygiene 57. Meningitis: Planning interventions for care (53): -Isolate client as soon as meningitis is expected -Implement fever reduction measures -report to public health department -Bed rest with HOB 30 degrees -Provide quiet environment and minimize exposure to bright light 17 / 31 -Avoid coughing and sneezing which increased ICP -Maintain safety and seizure precautions 58. Chest tube insertion and monitoring: Maintaining drainage system: First Chamber: Drainage collection Second Chamber: Water seal Third Chamber: Suction control Position client in semi-fowlers to high-fowlers position to promote optimal lung expansion - Tidaling with movement is expected in the water seal chamber - Cessation of tidaling in the water seal chamber signals lung reexpansion - Continuous bubbling in the water seal chamber (air leak finding) 18 / 31 59. Diabetes Mellitus Management: Sick Day Management: Monitor blood glu- cose every 3-4 hours Continue to take insulin or oral hypoglycemia agents consume 4oz sugar free liquid every 30 minutes meet carb needs with soft foods Test urine for ketones 60. Head Injury: indications of increased intracranial pressure: -Severe headache - Deteriorating LOC - Dilated, pinpoint or asymmetric pupils - Alteration in breathing pattern - Abnormal posturing - cerebrospinal fluid leakage 61. Hemodialysis and Peritoneal Dialysis: Intervening for decreased dialysate flow rate: -Reposition client -milk tubing -check tubing for kinks or closed clamps -Tell client to avoid constipation by taking stool softeners and consuming a diet high in fiber 62. Respiratory management and mechanical ventilation: caring for a client who has an ET tube: Maintain a patent airway -assess the position and placement of tube - Suction oral and tracheal secretions to maintain tube patency - Soft wrist restraints - Maintain cuff pressure below 20mm Hg 19 / 31 63. TB: Discharge teaching about TB: -Continue medication therapy for its full duration of 6-12 months -continue with follow-up care for 1 year -Sputum samples every 2-4 weeks, no longer contagious after 3 neg samples -proper hand hygiene -wear N95 64. Electrolyte imbalances: Treatment of hypokalemia: IV potassium supple- ment Never administer IV bolus Encourage foods high in K 65. Fluid imbalances: Assessment findings: Hypo: Increased Hct Increased urine specific gravity increased serum sodium 20 / 31 Hyper: Decreased Hct Normal sodium decreased electrolytes, BUN and creatinine Respiratory alkalosis 66. Fluid Imbalances: Clinical manifestations of hypervolemia: Tachycardia bounding pulse hypertension muscle weakness headache ascites orthopnea crackeles distended neck veins 67. Fluid Imbalances: Clinical manifestations of Dehydration: Hyperthermia tachycardia thready pulse hypotension decreased CVP tachypneic hypoxia dizziness syncope confusion 21 / 31 thirst decreased cap refill 68. Hyperthyroidism: Caring for a client following a thyroidectomy: Client in high fowlers position, support head and neck with pillow and avoid neck extension check surgical site for excessive bleeding have trach supplies immediately available Hypocalcemia can occur 69. Anemias: Manifestations of anemia: Pallor Fatigue irritability dypnea sensitivity to cold 22 / 31 tachycardia bright red tongue (vit b12 deficiency) 70. Hemodialysis and Peritoneal Dialysis: Manifestations of Peritonitis: Severe abdominal pain which worsens with movement 71. Anemias: Administering Epoetin Alfa: Monitor for an increase in blood pres- sure Monitor Hgb and Hct twice a week 72. Hepatitis and Cirrhosis: Priority findings to report: Supine position for liver biopsy Report: Hepatitis - Fever - Vomiting - Dark-colored urine - clay colored stools - Jaundice Cirrosis - Cognitive changes - Ascities -Jaundice - Petechiae - Palmar erythema -fruit or musty odor 73. Heart failure and pulmonary edema: treatment of cardiomyopathy: Loop Diuretics (Lasix) 23 / 31 Afterload reducing agents: Ace Inhibitors (Enalapril) Inotropic agents: Digoxin Beta Blockers: Metoprolol Vasodilators: Nitroglycerine 74. Disorders of the eye: Age related macular degeneration: Number 1 cause of vision loss in people <60 Dry Macular Degeneration: Smokers HTN Female Short body stature Family History Diet lacking carotene and Vitamin A 24 / 31 - Lack of depth perception - Distorted objects - Blurred vision - Loss of central vision - Blindness 75. Disorders of the eye: Indications of Glaucoma: Open Angle - Headache - Mild eye pain - loss of peripheral vision - decreased acommodation - Elevated IOP (>21) Angle- Closure - Rapid onset of elevated IOP - Decreased or blurred vision - Halos around lights - non reactive pupils - severe pain and nausea - photophobia 76. Posterior Pituitary Disorders: Medications to treat diabetes insipidus: Desmopressin acetate (DDAVP) - Notify weight gain >2 lbs in 24 hours Cabamazepine (Tegretol) -Notify sore throat, fever or bleeding 25 / 31 Vasopressin (Pitressin) - Notify headache or confusion 77. Head injury: Identification of altered respiratory patterns: Cheyne stokes respirations central neurogenic hyperventilation apnea 78. Emergency Nursing principles and management: Priority action for ab- dominal trauma (9): ABCDE (Airway, breathing, circulation, disability and expo- sure) 79. Hemodynamic Shock: Priority intervention for hypovolemic shock: Contin- uously monitor airway and vital signs Administer fluids (0.9% NaCl or Lactated Ringers) Have resuscitation equipment available 26 / 31 80. Hypertension: Action for hypertensive crisis: Administer IV anti-hyperten- sives therapies, such as nitroprusside, nicardipine and labetaolol Monitor BP every 5-15 minutes Assess neurological status Monitor Cardiac status 81. Emergency Nursing principles and management: Emergency Illness man- agement (9): Always assess airway, breathing and circulation FIRST 82. Fractures and immobilization devices: Assessing for compartment syn- drome (795): Compartment Syndrome assessment: Pain Paralysis Paresthesia Pallor Pulselessness Intense pain with movement numbness, burning and tingling are early signs 83. Asthma: Identifying pathophysiology: Chronic inflammatory disorder of the airways -Mucosal edema - Bronchoconstriction - Excessive mucus production - Dyspnea - Chest tightness 27 / 31 - Anxiety/Stress -Wheezing -Coughing - Poor O2 84. Parkinsons disease: Expected findings: - Stooped posture - Slow, Shuffling gait - Slow speech - Tremors - Muscle rigidity - Bradykinesia/ Akinesia -Autonomic Symptoms - Difficulty chewing and swallowing - Drooling 28 / 31 - Dysarthria - Difficulty with ADL's - Mood swings - Dementia 85. Rheumatoid Arthritis: Client teaching about early indications: Pain at rest with movement Morning stiffness fatigue joint swelling warmth and erythema 86. Acute kidney injury and chronic kidney disease: Metabolic changes asso- ciated with chronic kidney disease: Metabolic acidosis 87. Heart Failure and Pulmonary Edema: Recognizing manifestations of left sided heart failure: - Dyspnea, Orthopnea (SOB while laying down), nocturnal dyspnea - Fatigue - Displaced apical pulse (hypertrophy) - S3 heart sound (gallop) - Pulmonary congestion - Frothy sputum - Altered mental status - Decrease in urine output 88. Respiratory Failure: Manifestations of Acute respiratory failure: ABG val- ues: Room air, PaO2 <60 and SaO2 <90 PaO2 >50 in conjunction with a pH less than 7.30 - lack of perfusion to the capillary bed 29 / 31 89. Blood and blood product transfusions: Monitoring for adverse response to multiple blood transfusions: cute Hemolytic: chills, fever, low back pain, tachycar- dia, flushing, hypotension Febrile: chiils, fever, flushing, headache Mild Allergic: itching, urticaria and flushing Anaphylactic: wheezing, dyspnea, chest tightness cyanosis and hypotension 90. Hemodialysis and Peritoneal Dialysis: Assessment of an arteriovenous fistula: Alert nurse of signs of disequilibrium syndrome such as nausea and headache - Check for thrill or bruit 30 / 31 - Eat well balanced meals that include foods high in folate (beans, green vegetables) and increase protein 31 / 31