ATI RN
ATI Medical Surgical Proctored Exam Questions
Question 1 of 5
A nurse is caring for a client post-myocardial infarction (MI). What is the priority assessment for this client?
Correct Answer: C
Rationale: The correct answer is C: Assessing for chest pain. The priority assessment for a client post-MI is to monitor for any signs of recurrent chest pain or angina, as it could indicate ongoing cardiac ischemia or a new infarction. Prompt intervention is crucial in these situations to prevent further damage to the heart muscle. Monitoring urine output (A) and electrolyte levels (D) are important assessments but do not take precedence over assessing for chest pain. Checking blood glucose levels (B) is relevant for diabetic clients but is not the priority in this case.
Question 2 of 5
A client with heart failure has gained 2 kg (4.4 lbs) in the past 24 hours. What action should the nurse take first?
Correct Answer: B
Rationale: The correct answer is B: Assess the client's respiratory status. The first action should be to assess the client's respiratory status as the weight gain could indicate fluid retention leading to pulmonary congestion, a common complication in heart failure. By assessing the respiratory status, the nurse can determine if there are signs of respiratory distress such as increased work of breathing, crackles, or shortness of breath. This assessment will help in identifying any immediate need for interventions such as oxygen therapy or diuretics. Restricting fluid intake (choice A) is important but not the first step. Administering diuretics (choice C) should be based on assessment findings. Notifying the healthcare provider (choice D) can be done after assessing the client's respiratory status.
Question 3 of 5
A client with diabetes is experiencing symptoms of hypoglycemia. What should the nurse administer first?
Correct Answer: D
Rationale: The correct answer is D: 15-20 grams of fast-acting carbohydrate orally. In hypoglycemia, the immediate goal is to raise blood glucose levels quickly. Fast-acting carbohydrates like glucose tablets or juice are the most effective and fastest way to raise blood sugar levels. Administering insulin (choice A) would further lower blood sugar levels. Intravenous dextrose (choice B) is appropriate for severe cases but may not be necessary as the first step. Glucagon (choice C) is typically used if the client is unconscious or unable to consume oral carbohydrates.
Question 4 of 5
A nurse is caring for a client with a new diagnosis of type 1 diabetes. What is the most important aspect of teaching the nurse should focus on?
Correct Answer: B
Rationale: The correct answer is B, proper administration of insulin, because it is crucial for managing type 1 diabetes. Insulin is essential for regulating blood sugar levels in type 1 diabetes patients. Without proper insulin administration, the client's condition can deteriorate rapidly. Regular exercise (A) and a low-carbohydrate diet (C) are important aspects of diabetes management, but they are not as critical as ensuring proper insulin administration. Recognizing signs of hyperglycemia (D) is important, but knowing how to administer insulin correctly takes precedence in effectively managing type 1 diabetes.
Question 5 of 5
A nurse is assessing a client with a history of seizures. Which assessment finding requires immediate intervention?
Correct Answer: D
Rationale: The correct answer is D because prolonged seizures lasting longer than 5 minutes can lead to status epilepticus, a medical emergency that can cause brain damage or even death. Immediate intervention is necessary to stop the seizure activity. Auras (A) are warning signs of an impending seizure and do not require immediate intervention. Antiseizure medication within therapeutic range (B) indicates proper management. Being seizure-free for 2 years (C) is a positive outcome but does not require immediate intervention unless a seizure occurs.