ATI-Style Medical-Surgical Nursing Review

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Sample questions from ATI-Style Medical-Surgical Nursing Review

This material has 20 questions with answers and rationales. Here are the first 5.

1. 1.At change of shift, which client should the nurse assess first?

   • A.A. A client with stable heart failure who gained 0.5 kg over three days
   • B.B. A client two hours after thyroid surgery who has new inspiratory stridor
   • C.C. A client with diabetes whose premeal glucose is 186 mg/dL
   • D.D. A client with chronic arthritis requesting prescribed analgesia for usual pain

   Rationale: B is correct because new stridor suggests upper airway narrowing and possible rapidly progressing obstruction. A requires continued fluid assessment but does not describe immediate instability. C may require prescribed glucose management but is not an emergency by itself. D deserves timely pain treatment, but familiar chronic pain is less urgent than a threatened airway.

2. 2.A client receiving IV morphine becomes difficult to arouse and has a respiratory rate of 6/min. Oxygen saturation is 96% on supplemental oxygen. Which action is best?

   • A.A. Continue observation because the oxygen saturation is acceptable
   • B.B. Give the next opioid dose to prevent breakthrough pain
   • C.C. Stop further opioid administration, activate urgent assistance, support breathing, and administer naloxone according to protocol
   • D.D. Remove oxygen to determine the client's true saturation

   Rationale: C is correct because severe sedation and bradypnea indicate possible opioid-induced respiratory depression. Immediate ventilatory support and reversal treatment may be needed. A is wrong because oxygen can mask hypoventilation on pulse oximetry. B can worsen respiratory failure. D removes needed oxygen and delays treatment without correcting inadequate ventilation.

3. 3.A client with suspected acute coronary syndrome reports taking sildenafil recently. Which prescribed medication requires clarification before administration?

   • A.A. Sublingual nitroglycerin
   • B.B. Chewable aspirin, with no allergy or active bleeding
   • C.C. A prescribed high-intensity statin
   • D.D. Normal saline to maintain vascular access

   Rationale: A is correct because nitrates combined with recent phosphodiesterase-5 inhibitor use can cause profound hypotension. Verify the specific drug and timing. B is commonly appropriate in suspected acute coronary syndrome when not contraindicated. C does not have the same acute interaction. D does not create the nitrate-related interaction, although all fluids still require appropriate monitoring.

4. 4.A client with COPD and known risk for hypercapnic respiratory failure has an oxygen saturation of 82% and increased work of breathing. Which plan is most appropriate?

   • A.A. Withhold oxygen because it may reduce respiratory drive
   • B.B. Encourage sleep and reassess in one hour
   • C.C. Apply oxygen and leave it at the highest possible setting regardless of response
   • D.D. Apply controlled oxygen, urgently reassess, obtain blood gases as ordered, and initially target 88% to 92% unless individualized orders differ

   Answer and rationale are in the full material.

5. 5.A client develops sudden right arm weakness and difficulty speaking. Which set of actions is most appropriate?

   • A.A. Give oral aspirin, offer water, and schedule a routine neurologic consultation
   • B.B. Activate the stroke pathway, establish last known well time, check glucose, and keep the client NPO pending swallowing evaluation
   • C.C. Lower the blood pressure to a normal level using any available antihypertensive
   • D.D. Wait 30 minutes to determine whether symptoms resolve

   Answer and rationale are in the full material.