ATI RN Adult Medical Surgical Proctored 2023

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Sample questions from ATI RN Adult Medical Surgical Proctored 2023

This material has 70 questions with answers and rationales. Here are the first 5.

1. 1.In the emergency department, a 68-year-old client with a history of heart failure reports sudden shortness of breath while lying flat. The client is restless, has crackles halfway up both lung fields, and has an SpO2 of 84% on room air. Which action should the nurse take first?

   • A.Obtain the client's daily weight and compare it with the previous day's weight.
   • B.Encourage the client to use an incentive spirometer.
   • C.Administer the prescribed oral loop diuretic with a glass of water.
   • D.Place the client in high-Fowler position and apply supplemental oxygen.

   Rationale: Positioning upright and applying oxygen address the immediate threats of impaired oxygenation and pulmonary congestion. A daily weight is useful for evaluating fluid status but does not stabilize this client's acute hypoxemia. An oral diuretic may be part of treatment, but the client needs immediate respiratory support and the route may be inappropriate in an acute crisis. Incentive spirometry is not a treatment for acute pulmonary edema.

2. 2.A client's potassium is 6.4 mEq/L (reference range 3.5 to 5.0 mEq/L), and the electrocardiogram shows tall, peaked T waves. The client takes lisinopril and spironolactone for heart failure. Which prescribed intervention should the nurse anticipate first?

   • A.Administer IV calcium gluconate.
   • B.Encourage foods rich in potassium.
   • C.Give the scheduled spironolactone dose.
   • D.Administer oral potassium chloride.

   Rationale: IV calcium gluconate stabilizes the cardiac membrane when hyperkalemia is causing electrocardiographic changes; it does not remove potassium, but it reduces immediate dysrhythmia risk. Potassium replacement and potassium-rich foods would worsen the hyperkalemia. Spironolactone can increase potassium and should not be given while the level is critically elevated. The client will also need interventions to shift or remove potassium, but cardiac stabilization is the immediate priority.

3. 3.Refer to the client's chart. Which findings support concern for acute worsening of heart failure and require prompt follow-up? Select all that apply.

   • A.The client's weight has increased 1.8 kg in 2 days.
   • B.The client's heart rate is 88/min at 1000, compared with 84/min at 0800.
   • C.The client now needs three pillows to sleep, compared with one pillow at 0800.
   • D.The client reports new difficulty breathing when walking to the bathroom.
   • E.The client's SpO2 is 91% on room air at 1000, down from 96% at 0800.

   Rationale: The change from one pillow to three suggests worsening orthopnea, and a 1.8 kg weight gain over 2 days is consistent with fluid retention. The falling oxygen saturation and new exertional dyspnea are additional evidence of worsening pulmonary congestion and reduced functional tolerance. A heart rate increase from 84/min to 88/min, by itself, is a small change and does not indicate acute decompensation. The combination of trends matters more than an isolated mildly increased heart rate.

4. 4.At change of shift, the nurse receives report on four clients. Which client should the nurse assess first?

   • A.A client with chronic atrial fibrillation whose heart rate is 96/min and who is awaiting a scheduled medication
   • B.A client with hypertension whose blood pressure is 168/92 mm Hg and who denies headache, chest pain, or visual changes
   • C.A client 6 hours after femoral cardiac catheterization with a cool, pale foot and a newly absent pedal pulse on the catheterization side
   • D.A client with stable angina who reports the usual brief discomfort after walking to the bathroom, relieved by rest

   Answer and rationale are in the full material.

5. 5.A client taking warfarin for a mechanical heart valve calls the anticoagulation clinic after falling and striking the head. The client denies loss of consciousness and says, "I feel fine." Which instruction is the priority?

   • A.Apply a cold pack to the scalp and rest for the remainder of the day.
   • B.Seek emergency evaluation now, even though there are no symptoms.
   • C.Hold the next warfarin dose and call the clinic tomorrow.
   • D.Take the usual warfarin dose and report any bruising at the next appointment.

   Answer and rationale are in the full material.