ATI RN Adult Medical-Surgical Midterm Proctored Exam

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Sample questions from ATI RN Adult Medical-Surgical Midterm Proctored Exam

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 68-year-old client is 2 hours postoperative after a colectomy on a surgical unit. The client is restless, reports shortness of breath, and has a heart rate of 122/min, respiratory rate of 30/min, blood pressure of 138/82 mm Hg, and oxygen saturation of 86% on room air. Which action should the nurse take first?

   • A.Apply oxygen and assess respiratory status
   • B.Administer the prescribed opioid for incisional pain
   • C.Notify the surgeon and wait for further instructions
   • D.Encourage the client to use the incentive spirometer

   Rationale: Hypoxemia and tachypnea indicate an immediate breathing problem, so applying oxygen while assessing the airway and respiratory status is the priority. Opioids could worsen respiratory depression, and waiting to notify the surgeon delays support. Incentive spirometry is useful for prevention but is not the first intervention for acute desaturation.

2. 2.A 74-year-old client with heart failure is admitted to a medical unit with increasing dyspnea. The client is sitting upright, has crackles bilaterally, an oxygen saturation of 89% on room air, and a respiratory rate of 28/min. Which prescription should the nurse implement first?

   • A.Administer IV furosemide
   • B.Obtain a daily weight
   • C.Restrict oral fluids to 1,500 mL per day
   • D.Teach the client to limit sodium

   Rationale: IV furosemide can rapidly reduce pulmonary congestion and is the most immediate prescribed intervention for these acute findings. Daily weights and fluid and sodium restrictions are important management measures but will not promptly relieve respiratory distress. The nurse should also provide oxygen and reassess breathing while implementing treatment.

3. 3.A 59-year-old client with type 1 diabetes is being treated in the emergency department for diabetic ketoacidosis. The client's glucose is 560 mg/dL, potassium is 5.4 mEq/L, and arterial pH is 7.18. After starting prescribed isotonic IV fluids, which action is most important before initiating the insulin infusion?

   • A.Verify the current serum potassium level
   • B.Administer sodium bicarbonate
   • C.Give the client's usual long-acting insulin
   • D.Restrict potassium in the diet

   Rationale: Insulin shifts potassium into cells and can cause dangerous hypokalemia, so potassium must be checked and monitored before and during insulin therapy. Bicarbonate is not routinely used at this pH without a specific indication, and long-acting insulin does not replace the prescribed IV protocol. Dietary restriction does not address the immediate electrolyte risk.

4. 4.A 70-year-old client with chronic obstructive pulmonary disease is admitted with increased sputum and dyspnea. The client is alert, has an oxygen saturation of 84% on room air, and is prescribed oxygen. Which action is appropriate?

   • A.Apply low-flow oxygen and titrate to the prescribed target saturation
   • B.Withhold oxygen because it can suppress respiratory drive
   • C.Apply a nonrebreather mask at maximum flow and leave it unchanged
   • D.Have the client breathe into a paper bag

   Answer and rationale are in the full material.

5. 5.A 64-year-old client with acute pancreatitis is hospitalized with severe epigastric pain radiating to the back, a heart rate of 116/min, and a blood pressure of 94/58 mm Hg. Which prescription should the nurse implement first?

   • A.Begin the prescribed isotonic IV fluid bolus
   • B.Offer a low-fat meal
   • C.Administer an oral pancreatic enzyme
   • D.Assist the client to ambulate in the hallway

   Answer and rationale are in the full material.