ATI MEDSURGE2023 PDF

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Sample questions from ATI MEDSURGE2023 PDF

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

1. 1.In the emergency department, a 52-year-old client with type 2 diabetes reports nausea and unusual fatigue rather than chest pain. The client is pale and diaphoretic; blood pressure is 88/54 mm Hg, and the ECG shows ST elevation in leads II, III, and aVF. Which action should the nurse take first?

   • A.Give sublingual nitroglycerin to reduce myocardial oxygen demand
   • B.Administer an antacid and reassess the nausea in 30 minutes
   • C.Obtain a 12-lead ECG and notify the emergency response team of suspected acute myocardial infarction
   • D.Encourage the client to cough and take deep breaths

   Rationale: The atypical symptoms, hypotension, and inferior-lead ST elevation indicate an acute myocardial infarction requiring immediate escalation and rapid reperfusion evaluation. Nitroglycerin can worsen hypotension and should not be given before the low blood pressure is addressed. An antacid or breathing exercises would delay time-sensitive cardiac care.

2. 2.Refer to the client's chart. Which findings indicate that the client's heart failure is worsening and require prompt follow-up? Select all that apply.

   • A.New crackles are heard halfway up both lung fields
   • B.Client reports needing three pillows to sleep instead of one
   • C.Weight increased by 1.4 kg (3.1 lb) in 24 hours
   • D.Heart rate is 84/min and regular
   • E.Urine output is 35 mL/hr
   • F.Oxygen saturation decreased from 95% to 90% on room air

   Rationale: The rapid weight gain, falling oxygen saturation, new bilateral crackles, and increasing orthopnea are charted changes consistent with fluid accumulation and worsening heart failure. A urine output of 35 mL/hr is above the common adult minimum threshold of 30 mL/hr and, without a downward trend or other evidence, is not the strongest worsening cue here. A regular heart rate of 84/min is not, by itself, evidence of decompensation.

3. 3.A provider prescribes digoxin for a 63-year-old client with heart failure and atrial fibrillation. Before administering the dose, the nurse notes an apical pulse of 54/min and a potassium level of 3.0 mEq/L. Which action is best?

   • A.Hold the digoxin and notify the provider of the bradycardia and hypokalemia
   • B.Administer the digoxin and encourage a potassium-restricted diet
   • C.Administer the digoxin because atrial fibrillation requires rate control
   • D.Give the digoxin with food and recheck the pulse in 1 hour

   Rationale: A pulse of 54/min is below the usual hold parameter for digoxin, and hypokalemia increases myocardial sensitivity to digoxin and risk of toxicity. The nurse should withhold the dose and promptly report both findings for further instructions. Giving the dose with food does not address the bradycardia or electrolyte risk, and potassium restriction would worsen hypokalemia.

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

   • A.A 34-year-old client with chronic hypertension whose blood pressure is 154/90 mm Hg and who denies symptoms
   • B.A 72-year-old client with peripheral arterial disease who has a cool foot and a new absent pedal pulse
   • C.A 58-year-old client two days after cardiac catheterization with a small, unchanged bruise at the access site
   • D.A 41-year-old client with stable angina who reports the usual brief discomfort after walking to the bathroom

   Answer and rationale are in the full material.

5. 5.During a clinic visit, a 26-year-old client with a mechanical mitral valve asks how to reduce the risk of complications while taking warfarin. Which statement indicates correct understanding?

   • A.I will double my next dose if I forget to take one
   • B.I should take ibuprofen for a headache because it does not affect warfarin
   • C.I can stop the medication once my INR is in the target range
   • D.I will keep my intake of leafy green vegetables consistent from week to week

   Answer and rationale are in the full material.