ATI Medical Surgical Proctored Exam

ATI Medical Surgical Proctored Exam Related

Review ATI Medical Surgical Proctored Exam related questions and content

A client is on intravenous heparin to treat a pulmonary embolism. The client's most recent partial thromboplastin time (PTT) was 25 seconds. What action should the nurse anticipate?

  • A. Decrease the heparin rate.
  • B. Increase the heparin rate.
  • C. No change to the heparin rate.
  • D. Stop the heparin; start warfarin (Coumadin).
Correct Answer: B

Rationale: The correct answer is B: Increase the heparin rate. A PTT of 25 seconds indicates that the client's blood is not adequately anticoagulated, as the therapeutic range for PTT is typically around 60-80 seconds for heparin therapy. Therefore, the nurse should anticipate increasing the heparin rate to achieve the desired anticoagulant effect and prevent further clot formation.

Incorrect choices:
A: Decreasing the heparin rate would further decrease the anticoagulant effect, potentially putting the client at risk for thrombus progression.
C: No change to the heparin rate would not address the subtherapeutic PTT level and could lead to inadequate anticoagulation.
D: Stopping heparin and starting warfarin is not appropriate at this time as warfarin takes time to reach therapeutic levels, whereas heparin provides immediate anticoagulation for acute situations like a pulmonary embolism.

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During a preoperative review of systems, the patient reveals a history of renal disease. This finding suggests the need for which preoperative diagnostic tests?

  • A. ECG and chest x-ray
  • B. Serum glucose and CBC
  • C. ABGs and coagulation tests
  • D. BUN, serum creatinine, and electrolytes
Correct Answer: D

Rationale: Renal disease necessitates evaluating kidney function through tests like BUN, serum creatinine, and electrolytes.

When teaching a client with chronic obstructive pulmonary disease about oxygen by cannula, the nurse should also instruct the client's family to:

  • A. Avoid smoking near the client.
  • B. Turn off oxygen during meals.
  • C. Adjust the liter flow to 10 as needed.
  • D. Remind the client to keep mouth closed.
Correct Answer: A

Rationale: Smoking near oxygen poses a fire hazard and exacerbates respiratory issues.

When caring for an older adult client with a pulmonary infection, what action should the nurse take first?

  • A. Encourage the client to increase fluid intake.
  • B. Assess the client's level of consciousness.
  • C. Raise the head of the bed to at least 45 degrees.
  • D. Provide the client with humidified oxygen.
Correct Answer: B

Rationale: The correct answer is B: Assess the client's level of consciousness. This is the priority because changes in consciousness can indicate deteriorating respiratory status or potential respiratory distress. Next steps would depend on the assessment findings.
A: Encouraging fluid intake is important but not the first priority.
C: Raising the head of the bed helps with breathing but doesn't address potential immediate respiratory distress.
D: Providing humidified oxygen may be necessary but assessing consciousness comes first to determine the urgency of oxygen therapy.

A nurse working on a cardiac unit delegated taking vital signs to an experienced unlicensed assistive personnel (UAP). Four hours later, the nurse notes the client's blood pressure is much higher than previous readings & the client's mental status has changed. What action by the nurse would most likely have prevented this negative outcome?

  • A. Determining if the UAP knew how to take blood pressure
  • B. Double-checking the UAP by taking another blood pressure
  • C. Providing more appropriate supervision of the UAP
  • D. Taking the blood pressure instead of delegating the task
Correct Answer: C

Rationale: The correct answer is C: Providing more appropriate supervision of the UAP. By providing adequate supervision, the nurse can ensure that the UAP is performing tasks correctly and can intervene if any issues arise. This would have likely prevented the negative outcome as the nurse could have identified the high blood pressure and changed mental status earlier.

A: Determining if the UAP knew how to take blood pressure - While assessing the UAP's competence is important, it does not address the need for ongoing supervision and oversight.

B: Double-checking the UAP by taking another blood pressure - This approach does not address the root cause of the issue, which is the lack of appropriate supervision.

D: Taking the blood pressure instead of delegating the task - This is not a sustainable solution as delegating tasks to UAPs is a common practice in healthcare settings. Providing appropriate supervision is key to ensuring safe and effective delegation.

What drug would be most effective in relieving Mr. Stout’s bronchial spasm?

  • A. Potassium iodide
  • B. Ephedrine sulfate
  • C. Cromolyn sodium
  • D. Acetylcysteine (Mucomyst)
Correct Answer: B

Rationale: Ephedrine stimulates beta-adrenergic receptors, relaxing bronchial smooth muscle.

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