ATI Med-Surg 2 2023 Practice Exam

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Sample questions from ATI Med-Surg 2 2023 Practice Exam

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

1. 1.In the emergency department, a client with type 2 diabetes reports sudden nausea and unusual fatigue but denies chest pain. The ECG shows ST-segment elevation in leads II, III, and aVF. Which action should the nurse take first?

   • A.Administer sublingual nitroglycerin to relieve suspected ischemic discomfort.
   • B.Give the client's scheduled metformin with a small amount of water.
   • C.Encourage the client to walk briefly to assess activity tolerance.
   • D.Obtain a 12-lead ECG with right-sided leads and notify the provider of possible right ventricular involvement.

   Rationale: An inferior-wall STEMI can involve the right ventricle, and right-sided leads help identify this complication; right ventricular infarction is preload dependent and can worsen with nitrates. Nitroglycerin may be appropriate after blood pressure and right ventricular involvement are assessed, but it is not the safest first action here. Metformin is not an acute treatment and may be held around contrast studies, while ambulation is unsafe during an acute infarction. Older adults and clients with diabetes may have atypical ischemic symptoms, so fatigue and nausea require urgent evaluation.

2. 2.Refer to the client's chart. Which actions should the nurse take now in response to the client's change in condition? Select all that apply.

   • A.Prepare to administer the prescribed potassium supplement immediately, before reviewing the current potassium result.
   • B.Place the client in high-Fowler position and apply oxygen as prescribed to maintain the target saturation.
   • C.Administer the prescribed IV furosemide and reassess respiratory status and urine output.
   • D.Encourage the client to drink additional fluids to improve renal perfusion.
   • E.Notify the provider promptly about worsening hypoxemia, crackles, and reduced urine output.

   Rationale: The chart shows worsening dyspnea, new crackles, an SpO2 decline from 94% to 88%, and reduced urine output, consistent with deteriorating pulmonary congestion and requiring positioning, oxygen as prescribed, and prompt provider notification. The prescribed IV furosemide addresses fluid overload, with respiratory status and urine output reassessed after administration. Giving potassium before reviewing the current result is unsafe because potassium is 4.1 mEq/L and supplementation is not indicated from the chart; extra fluids could worsen congestion. The falling oxygen saturation and urine output are important trends, not isolated findings.

3. 3.At an outpatient anticoagulation clinic, a client taking warfarin for atrial fibrillation reports black, tarry stools and lightheadedness. The INR is 5.8, and the client is alert with a blood pressure of 104/66 mm Hg. Which action is the priority?

   • A.Ask the client to walk around the clinic while the nurse obtains a repeat INR.
   • B.Recommend adding leafy green vegetables to the diet today and rechecking the INR in one week.
   • C.Hold the warfarin and promptly notify the provider about suspected bleeding and the elevated INR.
   • D.Instruct the client to take the usual warfarin dose with food to reduce stomach irritation.

   Rationale: Melena with an INR of 5.8 indicates possible clinically significant bleeding and requires holding warfarin and urgent provider notification. Taking the usual dose could worsen bleeding, and dietary vitamin K is not an adequate response to active suspected hemorrhage. A repeat INR may be ordered, but delaying escalation or encouraging ambulation does not address the immediate safety risk. Warfarin clients should report bleeding promptly rather than self-correcting anticoagulation through diet.

4. 4.A client with a mechanical mitral valve is preparing for discharge after valve replacement. Which statement indicates the need for further teaching?

   • A.I can stop warfarin once I have been free of symptoms for several months.
   • B.I will tell my dentist that I have a mechanical heart valve before procedures.
   • C.I will contact the clinic if I notice blood in my urine or stool.
   • D.I will take warfarin as prescribed and keep my INR appointments.

   Answer and rationale are in the full material.

5. 5.During a home visit, a client with peripheral arterial disease reports calf pain after walking one block that resolves with rest. Which instruction is most appropriate?

   • A.Avoid walking because exercise increases the risk of arterial occlusion.
   • B.Walk until moderate discomfort occurs, rest until it resolves, and repeat as tolerated.
   • C.Apply a heating pad to the feet each evening to improve circulation.
   • D.Elevate the legs above the level of the heart whenever resting.

   Answer and rationale are in the full material.