ATI Med-Surg Exam Esi

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Sample questions from ATI Med-Surg Exam Esi

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

1. 1.In the emergency department, a 67-year-old client reports crushing chest pressure radiating to the jaw. The ECG shows ST-segment elevation in leads II, III, and aVF. Which action should the nurse anticipate as the priority?

   • A.Encourage the client to ambulate to assess exercise tolerance
   • B.Administer a sublingual nitrate and delay further evaluation until the pain resolves
   • C.Prepare the client for urgent reperfusion therapy
   • D.Obtain a fasting lipid panel before initiating treatment

   Rationale: ST elevation with ischemic symptoms indicates an acute ST-elevation myocardial infarction requiring rapid reperfusion, such as percutaneous coronary intervention. A lipid panel is useful for risk management but must not delay emergency treatment. Nitrates may be prescribed when appropriate, but relief of pain does not rule out infarction or justify delaying reperfusion. Ambulation increases myocardial oxygen demand and is unsafe during an acute infarction.

2. 2.A client states, 'I gained 2.3 kg (5 lb) this week, and I need three pillows to sleep.' The client has chronic heart failure. Which instruction is most appropriate?

   • A.Call the health care provider today to report the weight gain and worsening orthopnea
   • B.Increase sodium intake to maintain circulating volume
   • C.Wait until the next scheduled appointment if there is no chest pain
   • D.Take an extra dose of the prescribed diuretic without contacting the provider

   Rationale: Rapid weight gain and worsening orthopnea can indicate fluid retention and worsening heart failure, so the client should promptly contact the provider for assessment and possible treatment changes. Taking an extra diuretic without instructions can cause hypotension or electrolyte abnormalities. Increasing sodium can worsen fluid retention. Absence of chest pain does not make these signs safe to ignore.

3. 3.Refer to the client's chart. Which findings require the nurse to take immediate action for this client with acute chest pain? Select all that apply.

   • A.The client has new ST-segment elevation on the repeat ECG
   • B.The client is diaphoretic and reports nausea
   • C.The chest pressure continues despite rest
   • D.The client asks whether a family member can bring a phone charger
   • E.The troponin I level is above the laboratory reference range

   Rationale: Persistent chest pressure, diaphoresis with nausea, an elevated troponin I, and new ST-segment elevation are consistent with ongoing myocardial injury and require immediate escalation and treatment. The chart shows pain continuing from 1015 to 1030 and new ECG changes at 1030, while the troponin I is 0.18 ng/mL, above the stated reference range. The request for a phone charger is not a physiologic sign of deterioration and should not take priority over the acute cardiac findings.

4. 4.Which finding in a 15-year-old with a history of repaired congenital heart disease should the nurse report promptly as a possible sign of infective endocarditis?

   • A.Heart rate of 88/min after walking to the clinic
   • B.A grade 2/6 systolic murmur documented at the last cardiology visit
   • C.Mild soreness at the site of a recent immunization
   • D.Temperature of 38.4 C with new petechiae on the lower legs

   Answer and rationale are in the full material.

5. 5.At a community clinic, a 74-year-old client taking warfarin for atrial fibrillation reports black, tarry stools. Which action should the nurse take first?

   • A.Recommend increasing dietary vitamin K immediately
   • B.Assess the client for bleeding and notify the provider promptly
   • C.Advise the client to skip warfarin for one week
   • D.Reassure the client that dark stools are an expected effect of warfarin

   Answer and rationale are in the full material.