ATI Advanced Medical Surgical Respiratory

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Sample questions from ATI Advanced Medical Surgical Respiratory

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

1. 1.In the emergency department, a 16-year-old client with a history of rheumatic heart disease reports sudden palpitations and dizziness. The monitor shows a regular narrow-complex tachycardia at 190/min. The client is alert, BP is 108/68 mm Hg, and there is no chest pain. Which intervention should the nurse anticipate first?

   • A.Begin chest compressions
   • B.Prepare for synchronized cardioversion
   • C.Coach the client to perform a vagal maneuver
   • D.Administer IV adenosine as a rapid push without further assessment

   Rationale: For a stable client with regular narrow-complex tachycardia, a vagal maneuver is an appropriate initial intervention. Synchronized cardioversion is generally indicated when the tachycardia causes hemodynamic instability, which is not described here. Adenosine may be prescribed if vagal maneuvers are ineffective, but it is not the first step in this stable client; chest compressions are indicated for cardiac arrest, not an alert client with a pulse.

2. 2.Refer to the client's chart. Which findings require the nurse to notify the provider promptly because they indicate worsening acute heart failure? Select all that apply.

   • A.Crackles are now heard halfway up both lung fields
   • B.Urine output averages 20 mL/hr over the last 2 hours
   • C.Heart rate decreases from 104/min to 92/min while BP remains stable
   • D.The client reports sleeping with three pillows for several months
   • E.SpO2 decreases from 94% on room air to 88% on room air

   Rationale: The decrease in SpO2 to 88% and the new crackles extending halfway up both lung fields indicate worsening pulmonary congestion and impaired oxygenation. Urine output of 20 mL/hr is low and may signal reduced renal perfusion or worsening cardiac output. Sleeping with three pillows is a chronic symptom in this chart, while the heart rate decreasing to 92/min with a stable blood pressure is not, by itself, evidence of deterioration.

3. 3.A client states, "I take warfarin for a mechanical heart valve, and my gums bleed when I brush." Which instruction is most appropriate?

   • A.Use aspirin for discomfort because it does not affect warfarin
   • B.Take an extra dose of warfarin if a dose was missed this week
   • C.Stop taking warfarin until the bleeding resolves
   • D.Use a soft-bristled toothbrush and contact the anticoagulation clinic about the bleeding

   Rationale: A soft-bristled toothbrush can reduce gingival trauma, and new bleeding should be reported so the client's INR and anticoagulation plan can be assessed. Stopping warfarin without a prescription can increase the risk of valve thrombosis. Taking an extra dose is unsafe, and aspirin can increase bleeding risk when combined with warfarin.

4. 4.A client's potassium is 6.4 mEq/L, and the ECG shows peaked T waves. Which prescribed medication should the nurse expect to administer first to reduce the immediate risk of a lethal dysrhythmia?

   • A.IV calcium gluconate
   • B.IV spironolactone
   • C.Oral potassium chloride
   • D.Subcutaneous epoetin alfa

   Answer and rationale are in the full material.

5. 5.During a home visit, a 28-year-old pregnant client at 30 weeks reports a severe headache and seeing spots. BP is 168/112 mm Hg, and urine dipstick testing shows 3+ protein. Which action should the nurse take?

   • A.Explain that protein in the urine is an expected finding late in pregnancy
   • B.Arrange immediate evaluation in an obstetric setting
   • C.Encourage the client to lie flat on the back and rest at home
   • D.Recommend a low-sodium diet and recheck the blood pressure in 1 week

   Answer and rationale are in the full material.