2022-2023 ATI RN Medical Surgical Exam with Answers (269 Solved Questions)

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2022-2023 RN MEDICAL SURGICAL ATIEXAM/MEDICAL SURGICAL ATI EXAM 2022-2023 QUESTIONS AND ANSWERS |ALREADYGRADED A | BRAND NEW!!1.CORONARYARTERYDISEASEANDACUTECORONARYSYNDROME2.Thenurseisdevelopingateachingplanfora64-year-oldpatientwithcoronaryarterydisease(CAD).Whichfactorshouldthenursefocusonduringtheteachingsessionx?a.Familyhistoryofcoronaryarterydiseaseb.Elevatedlow-densitylipoprotein(LDL)levelc.Greaterriskassociatedwiththepatient’sgenderd.IncreasedriskofcardiovasculardiseasewithagingANS:BRNshouldfocusonthept’sLDLlevel.↓LDLwillhelp↓thept’sriskfordevelopingCAD.3.Whichnursinginterventionislikelytobemosteffectivewhenassistingtheptw/CADtomakeappropriate dietary∆?a.Informthepatientaboutadietcontainingnosaturatedfatandminimalsalt.b.Emphasize the increased cardiac risk unless the patient makes dietary changes.c.Helpthepatientmodifyfavoritehigh-fatrecipesbyusingmonounsaturatedoils.d.Givethepatientalistoflow-sodium,low-cholesterolfoodstoincludeinthediet.ANS:CLifestyle changes are more likely to be successful when consideration is given to the patient’svaluesandpreferences.Thehighestpercentageofcaloriesfromfatshouldcomefrommonounsaturatedorpolyunsaturatedfats.4.Thenurseisadmittingapatientwhohaschestpain.Whichassessmentdatasuggestthatthepainisfromanacute MI?a.Thepainincreaseswithdeepbreathing.b.Thepainhaslastedlongerthan30minutes.c.Thepainisrelievedafterthepatienttakesnitroglycerin.d.Thepainisreproduciblewhenthepatientraisesthearms.ANS:B5.Whichinfofromapthelpsthenurseconfirmthepreviousdxofchronicstableangina?a.“Thepainwakesmeupatnight.”b.“Thepainislevel3to5(0to10scale).”c.“The pain has gotten worse over the last week.”d.“Thepaingoesawayafteranitroglycerintablet.”ANS:DChronicstableanginaistypicallyrelievedbyrestornitroglycerin6.WhichptstatementindicatesthattheRN’steachingaboutsublingnitroglycerin(Nitrostat)hasbeeneffective?a.“Icanexpectnauseaasasideeffectofnitroglycerin.”

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b.“IshouldonlytakenitroglycerinwhenIhavechestpain.”c.“Nitroglycerinhelpspreventaclotfromformingandblockingbloodflowtomyheart.”d.“IwillcallanambulanceifIhavepainaftertaking3nitroglycerin5minutesapart.”ANS:D

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7.Whichstatementmadebyaptw/CADafterthenursehascompletedteachingaboutthethxlifestylechanges(TLC)dietindicatesthatfurtherteachingisneeded?a.“Iwillswitchfromwholemilkto1%milk.”b.“IlikesalmonandIwillplantoeatitmoreoften.”c.“IcanhaveaglassofwinewithdinnerifIwantone.”d.“Iwillmissbeingabletoeatpeanutbuttersandwiches.”ANS:D8.Whichptstatementindicatesthatthenurse’steachingaboutcarvedilol(Coreg)forpreventinganginalepisodeshasbeeneffective?a.“Carvedilolwillhelpmyheartmuscleworkharder.”b.“Itisimportantnottosuddenlystoptakingthecarvedilol.”c.“Icanexpecttofeelshortofbreathwhentakingcarvedilol.”d.“Carvedilolwillincreasethebloodflowtomyheartmuscle.”ANS:BCandevelopintenseandfrequentanginaifthemedicationissuddenlyDC’d9.AptwhohashadchestpainforseveralhoursisadmittedwithadiagnosisofruleoutAMI.WhichlaboratorytestismostspecificforthenursetomonitorindeterminingwhetherthepatienthashadanAMI?a.Myoglobinb.Homocysteinec.C-reactiveproteind.Cardiac-specifictroponinANS:DTroponin levels ↑about 4-6 hrs after the onset of myocardial infarction (MI) and are highlyspecificindicatorsforMI.Myoglobinisreleasedwithin2hoursofMI,butitlacksspecificityanditsuseislimited. The other laboratory data are useful in determining the patient’s risk for developing coronaryarterydiseasebutarenothelpful indeterminingwhetheranacute MIisinprogress.10.Diltiazem(Cardizem)isRxforaptw/newlydxPrinzmetal’s(variant)angina.Whichactionofdiltiazemisaccurateforthenursetoincludeintheteaching plan?a.Reducesheartpalpitations.b.Preventscoronaryarteryplaque.c.Decreasescoronaryarteryspasms.d.Increasescontractileforceoftheheart.ANS:CPrinzmetal’sanginaiscausedbycoronaryarteryspasm.Calciumchannelblockers(e.g.,diltiazem,amlodipine[Norvasc])are afirst-line therapyforthistype ofangina.•Lipid-loweringdrugshelp↓atherosclerosis(plaqueformation)•and-adrenergicblockers↓sympatheticstimulationof<3(palpitations).11.Whichdataindicatestothenursethattheptw/stableanginaisexperiencingSEofmetoprolol?a.Patientisrestlessandagitated.b.Patient reportsfeeling anxious.c.Bloodpressureis90/54mmHg.

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d.Heartmonitorshowsnormalsinusrhythm.ANS:C12.Nadolol(Corgard)Rxforapatientwithchronicstableanginaandleftventriculardysfunction.Whatdatawouldindicate tothenurse thatthedrug iseffective?a.Decreasedbloodpressureandheartrateb.Improvementinthestrengthofthedistalpulsesc.Fewer complaints of having cold hands and feetd.Participationindailyactivitieswithoutchestpaine.ANS:D13.Heparinisorderedforaptwithanon–ST-segment-elevationmyocardialinfarction(NSTEMI).Howshouldthe nurseexplainthepurposeof theheparintothepatient?a.“Heparinenhancesplateletaggregationattheplaquesite.”b.“Heparindecreasesthesizeofthecoronaryarteryplaque.”c.“Heparinpreventsthedevelopmentofnewclotsinthecoronaryarteries.”d.“Heparindissolvesclotsthatareblockingbloodflowinthecoronaryarteries.”ANS:14.WhichactionwillnursetaketoevaluatetheeffectivenessofIVnitroglycerinforaptw/MI?a.Monitor heart rate.b.Askaboutchestpain.c.Checkbloodpressure.d.Observefordysrhythmias.ANS:B15.A patient with ST-segment elevation in 3 contiguous ECG leads is admitted to ED & dx as havingST-segment-elevationMI(STEMI).Whichqshouldthenurseasktodeterminewhethertheptisacandidatefor thrombolytic therapy?a.“Doyouhaveanyallergies?”b.“Doyoutakeaspirindaily?”c.“Whattimedidyourpainbegin?”d.“Canyouratethepainona0to10scale?”ANS:CThrombolytictherapyshouldbestartedwithin6hoursoftheonsetofMIDIF:CognitiveLevel:Apply(application)16.AptwhohasrecentlyhadanacuteMI(AMI)ambulatesinthehospitalhallway.Whichdatawouldindicatetothe nursethatthe patientshouldstopandrest?a.O2saturationdropsfrom99%to95%.b.Heartrateincreasesfrom66to98beats/min.c.Respiratoryrategoesfrom14to20breaths/min.d.Bloodpressure(BP)changesfrom118/60to126/68mmHg.ANS:B

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17.ThenurseisadministeringathrombolyticagenttoapatientwithanAMI.Whatpatientdataindicatesthatthe nurseshouldstopthedrug infusion?a.Bleedingfromthegumsb.Anincreaseinbloodpressurec.Decreasedlevelofconsciousnessd.AnonsustainedepisodeofventriculartachycardiaANS:Cpatientmaybeexperiencingintracranialbleeding18.AptrecoveringfromMIdevelopschestpainonday3that↑whentakingadeepbreathandisrelieved by leaning forward. Which action should nurse take as focused follow-up on thissymptom?a.Assessbothfeetforpedaledema.b.Palpatetheradialpulsesbilaterally.c.Auscultateforapericardialfrictionrub.d.Checktheheartmonitorfordysrhythmias.ANS:CThepatient’ssymptomsareconsistentwiththedevelopmentofpericarditis,apossiblecomplicationofMI.19.InpreparationforDC,nurseteachesaptw/chronicstableanginahowtousetheRxshort-actingandlong-actingnitrates.Whichptstatementindicatesthattheteachinghasbeeneffective?a.“IwillsitdownbeforeIputthenitroglycerinundermytongue.”b.“IwillcheckmypulseratebeforeItakeanynitroglycerintablets.”c.“IwillputthenitroglycerinpatchonassoonasIgetanychestpain.”d.“Iwillremovethenitroglycerinpatchbeforetakingsublingualnitroglycerin.”ANS:A20.Thenurseiscaringforapatientwhoisrecoveringfromasuddencardiacdeath(SCD)eventandhasnoevidenceofAMI.Whatshouldthenurseanticipateteachingthepatient?a.Sudden cardiac death events rarely reoccur.b.Additionaldiagnostictestingwillberequired.c.Long-termanticoagulationtherapywillbeneeded.d.LimitingphysicalactivitywillpreventfutureSCDevents.ANS:BDiagnostictesting(e.g.,stresstest,Holtermonitor,electrophysiologicstudies,cardiaccatheterization)isusedtodeterminethepossiblecauseoftheSCDandtreatmentoptions.21.ptw/DMandchronicstableanginahasaneworderforcaptopril.Whatshouldthenurseteachthispatientaboutthe primarypurposeof captopril?a.Decreasestheheartrate.b.Controlsbloodglucoselevels.c.Preventschangesinheartmuscle.d.Reducesthefrequencyofchestpain.ANS:C(ACE)

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22.AfterhavingMIandsuccessfulpercutaneouscoronaryintervention,ptstates,“Itwasjustalittlechest pain. As soon as I get out of here, I’m going for my vacation as planned.” Which replywouldbe mostappropriateforthe nursetomake?a.“Whatdoyouthinkcausedyourchestpain?”b.“Whereareyouplanningtogoforyourvacation?”c.“Sometimesplansneedtochangeafteraheartattack.”d.“Recoveryfromaheartattacktakesatleastafewweeks.”ANS:Aptexperiencingdenial,testreality23.Thenurseisevaluatingtheeffectivenessofpreoperativeteachingwithapatientscheduledforcoronaryarterybypassgraft(CABG)surgeryusingtheinternalmammaryartery.Whichpatientstatementindicatesthatadditionalteaching isneeded?a.“Theywillcirculatemybloodwithamachineduringsurgery.”b.“Iwillhaveincisionsinmylegwheretheywillremovethevein.”c.“Theywilluseanarterynearmyhearttogoaroundtheareathatisblocked.”d.“Iwillneedtotakeaspirineverydayafterthesurgerytokeepthegraftopen.”ANS:B24.AptwhoisrecoveringfromanAMIasksthenurseaboutsafelyresumingsex.Whichresponsebythe nurseisbest?a.“Mostpatientsareabletoenjoyintercoursewithoutanycomplications.”b.“Sexualactivityusesaboutasmuchenergyasclimbingtwoflightsofstairs.”c.“Thedoctorwillprovidesexualguidelineswhenyourheartisstrongenough.”d.“Holdingandcuddlingaregoodwaystomaintainintimacyafteraheartattack.”ANS:B25.Aptw/hyperlipidemiahasaneworderforcolesevelam(Welchol).Whichnursingactionisappropriate whenscheduling thismed?a.Administerthemedicationatthepatient’susualbedtime.b.Havethepatienttakethecolesevelam1hourbeforebreakfast.c.Givethepatient’sothermedications2hoursaftercolesevelam.d.Havethepatienttakethedoseatthesametimeastheprescribedaspirin.ANS:CThebileacidsequestrantsinterferewiththeabsorptionofmanyotherdrugs26.RNcaringforptwhowasadmittedtothecoronarycareunitfollowinganAMIandpercutaneouscoronaryinterventionthepreviousday.Whatshouldteachingforthisptincludetoday?a.TypicalemotionalresponsestoAMIb.Whencardiacrehabilitationwillbeginc.Pathophysiologyofcoronaryarterydiseased.InformationregardingdischargemedicationsANS:B27.Aptwhohasrecentlystartedtakingpravastatin(Pravachol)&niacinreportsseveralsxtothenurse.Whichinformationismostimportanttocommunicatetothehealthcareprovider?

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a.Generalizedmuscleachesandpainsb.Dizzinesswithrapidpositionchangesc.Nauseawhentakingthedrugsbeforemealsd.FlushingandpruritusaftertakingthedrugsANS:Amachesandpainsmayindicatemyopathyandrhabdomyolysis,whichhaveczacutekidneyinjuryand death in some patients who have taken the statin medications. Thesesymptoms indicate that thepravastatinmay needtobe discontinued.28.ApatientwhoisbeingadmittedtotheEDwithintermittentchestpaingivesthefollowinglistofdaily medications to the nurse. Which medication has the most immediate implications for thepatient’scare?a.Tadalafil(Cialas)b.Furosemide(Lasix)c.c.Warfarin(Coumadin)d.d.Diltiazem(Cardizem)ANS:AThe nurse will need to avoid giving nitrates to the patient because nitrate administration iscontraindicatedinpatientswhoareusingtadalafilbecauseoftheriskofseverehypotensioncausedbyvasodilation.29.Whichassessmentfindinginapatientwhohashadcoronaryarterybypassgraftingusingarightradialarterygraftismostimportantforthenursetocommunicatetothehealthcareprovider?a.Complaintsofincisionalchestpainb.Pallorandweaknessoftherighthandc.Finecracklesheardatbothlungbasesd.RednessonbothsidesofthesternalincisionANS:BThe∆intherighthandindicatecompromisedbloodflow,whichrequiresimmediateevaluationandactions,suchasprescribedcalciumchannelblockers orsurgery.30.Thenurseiscaringforaptwhohasjustarrivedonthetelemetryunitafterhavingcardiac(LPN/VN)?a.Teach the patient about the postprocedure plan of care.b.Givethescheduledaspirinandlipid-loweringmedication.c.Performtheinitialassessmentofthecatheterinsertionsite.d.Titratetheheparininfusionaccordingtotheagencyprotocol.ANS:B31.Which(ECG)∆byaptw/chestpainismostimportantforRNtoreportrapidlytoHCP?a.InvertedPwaveb.Sinustachycardiac.c.ST-segmentelevationd.d.First-degreeatrioventricularblockANS:CTheptislikelytobeexperiencinganST-segment-elevationmyocardialinfarction.

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32.Apatientwithacutecoronarysyndromehasreturnedtothecoronarycareunitafterhavingangioplasty with stent placement. Which assessment data indicate the need for immediateactionby the nurse?a.Reportofchestpainb.Heart rate 102 beats/minc.Pedalpulses1+bilaterallyd.Bloodpressure103/54mmHgANS:CThepatient’schestpainindicatesthatrestenosisofthecoronaryarterymaybeoccurringandrequiresimmediateactions,suchasadministrationofoxygenandnitroglycerin,bythenurse.33.Apatientadmittedtothecoronarycareunit(CCU)withanST-segment-elevationMI(STEMI)isrestless and anxious. The BP is 86/40 mm Hg, and HR is 132 beats/min. Based on thisinformation,whichpatientproblemisthepriority?a.Anxietyb.Acutepainc.Stressmanagementd.DecreasedcardiacoutputANS:DThehypotensionandtachycardiaindicate↓CO&shockfromthendamagedmyocardium.34.Whenadmittingapatientwithanon–ST-segment-elevationMI(NSTEMI)totheICU,whichactionshouldthe nurseperformfirst?a.Attachtheheartmonitor.b.Obtainthebloodpressure.c.Assesstheperipheralpulses.d.d.Auscultatethebreathsounds.ANS:A35.WhichinformationaboutapatientreceivingthrombolytictherapyforanAMIismostimportantforthe nursetocommunicatetothehealthcareprovider?a.Anincreaseintroponinlevelsfrombaselineb.Alargebruiseatthepatient’sIVinsertionsitec.Nochangeinthepatient’sreportedlevelofchestpaind.AdecreaseinST-segmentelevationontheelectrocardiogramANS:CContinuedchestpainsuggeststhatthethrombolytictherapyisnoteffectiveandthatotherinterventionssuchaspercutaneouscoronaryinterventionmaybeneeded.36.ThenurseobtainsthefollowingdatawhenassessingapatientwhoexperiencedaSTEMI2dayspreviously.WhichinfoismostimportanttoreporttoHCP?a.Thetroponinleveliselevated.b.Thepatientdenieshavingaheartattack.c.Bilateralcracklesinthemid-lowerlobes.d.Occasionalprematureatrialcontractions(PACs).

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ANS:CThecracklesindicatethatthepatientmaybedevelopingheartfailure,apossiblecomplicationofmyocardialinfarction(MI).Thehealthcareprovidermayneedtoordermedicationssuchasdiureticsorangiotensin-convertingenzyme inhibitorsfor the patient.37.ApatienthadaNSTEMI3daysago.Whichnursinginterventionisappropriatefortheregisterednurse(RN)todelegatetoanexperiencedlicensedpractical/vocationalnurse(LPN/VN)?a.Reinforcementofteachingabouttheprescribedmedicationsb.Evaluationofthepatient’sresponsetowalkinginthehallwayc.Completionofthereferralformforahomehealthnursefollow-upd.EducationofthepatientaboutthepathophysiologyofheartdiseaseANS:A38.A patient who has chest pain is admitted to the ED , and all of the following items areprescribed.Whichoneshouldthenursearrangetobecompletedfirst?a.Chestx-rayb.Troponinlevelc.Electrocardiogram(ECG)d.InsertionofaperipheralIVANS:C39.Afterreceivingchange-of-shiftreportaboutthefollowingfourpatientsonthecardiaccareunit,whichpatientshouldthe nurseassessfirst?a.39-year-oldpatientwithpericarditiswhoiscomplainingofsharp,stabbingchestpain.b.A56-year-oldpatientwithvariantanginawhoisscheduledtoreceivenifedipinec.A65-year-oldpatientwhohadamyocardialinfarction(MI)4daysagoandisanxiousabouttoday’splanneddischarge.d.A59-year-oldpatientwithunstableanginawhohasjustreturnedafterae.percutaneouscoronaryintervention(PCI).ANS:DAfter PCI, the patient is at risk for hemorrhage from the arterial access site. The nurse shouldassessthepatient’sbloodpressure,pulses,andtheaccesssiteimmediately.Theotherpatientsshouldalsobeassessedasquicklyaspossible,butassessmentofthispatienthasthehighestpriority.40.Toimprovethephysicalactivitylevelforamildlyobese68-year-oldpatient,whichactionshouldthe nurseplantotake?a.Stressthatweightlossisamajorbenefitofincreasedexercise.b.Determinewhatkindofphysicalactivitiesthepatientusuallyenjoys.c.Tellthepatientthatolderadultsshouldexercisefornomorethan20minutesatatime.d.Teachthepatienttoincludeashortwarm-upperiodatthebeginningofphysicalactivity.ANS:BBecause patients are more likely to continue physical activities that they already enjoy, the nursewillplantoaskthepatientaboutpreferredactivities.Thegoalforolderadultsis30minutesofmoderateactivity on most days. Older adults should plan for a longer warm-up period. Benefits of exercises, suchas improved activity tolerance, should be emphasized rather than aiming for significant weight loss inoldermildly obeseadults.

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41.Whichpatientatthecardiovascularclinicrequiresthemostimmediateactionbythenurse?a.Patientwithtype2diabeteswhosecurrentbloodglucoselevelis145mg/dL.b.Patientwithstableanginawhosechestpainhasrecentlyincreasedinfrequency.c.Patientwithfamilialhypercholesterolemiaandatotalcholesterolof465mg/dL.d.Patientwithchronichypertensionwhosebloodpressuretodayis172/98mmHg.ANS:B42.Thenursereviewsinformationshownintheaccompanyingfigurefromthemedicalrecordsofa43-year-oldpatient.Whichriskfactormodificationforcoronaryarterydiseaseshouldthenurseincludeinpatientteaching?a.Importanceofdailyphysicalactivityb.Effectofweightlossonbloodpressurec.Dietarychangestoimprovelipidlevelsd.CardiacriskassociatedwithprevioustobaccouseANS:CThepatienthasanelevatedlow-densitylipoproteincholesterolandlowhigh-densitylipoproteincholesterol,whichwillincreasethe riskof coronaryartery disease.43.After reviewinga patient’s history, vital signs, physical assessment, and laboratory data, whichinformationshownintheaccompanyingfigureismostimportantforthenursetocommunicatetothe HCP?a.Hyperglycemiab.Bilateralcracklesc.QwavesonECGd.ElevatedtroponinANS:BPulmonarycongestionsuggeststhatthepatientmaybedevelopingheartfailure2.HEARTFAILURE1.Whileassessinganolderadultpatient,thenursenotesjugularvenousdistention(JVD)withtheheadofthepatient’sbedelevated45degrees.Whatdoesthisfindingindicate?a.Decreasedfluidvolumeb.Jugularveinatherosclerosisc.Increasedrightatrialpressured.IncompetentjugularveinvalvesANS:CThejugularveinsemptyintothesuperiorvenacavaandthenintotherightatrium,soJVDwiththepatientsittingata45-degreeangle reflectsincreasedrightatrialpressure.2.The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for tx ofacutedecompensatedheartfailure(ADHF)withsevereorthopnea.Whichclinicalfindingisthebestindicator tx beeneffective?a.Weightlossof2lbin24hoursb.Hourlyurineoutputgreaterthan60mLc.Reduceddyspneawiththeheadofbedat30degrees

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d.PatientdeniesexperiencingchestpainorchestpressureANS:CBecausept’smajorclinicalmanifestationofADHFisorthopnea(causedbythepresenceoffluidinthe alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the headof the bedat30degrees.3.WhichtopicwillRNplantoincludeinDCteachingforptw/HFreducedejectionfraction(HFrEF)?a.Needtobeginanaerobicexerciseprogramseveraltimesweeklyb.Benefitsandeffectsofangiotensin-convertingenzyme(ACE)inhibitorsc.Useofsaltsubstitutestoreplacetablesaltwhencookingandatthetabled.ImportanceofmakinganannualappointmentwiththehealthcareproviderANS:BThecoremeasuresfortxofHFindicatethatptsw/anejectionfractionbelow40%shouldreceiveanACE inhibitorto↓ progressionofHF.4.IVNa+nitroprussideisorderedforptw/acutepulmonaryedema.Whichreassessmentfindingduring1sthrsofadminindicatesthatRNshould↓therateofnitroprussideinfusion?a.Ventricularectopyb.Dry,hackingcoughc.SystolicBPbelow90mmHgd.Heartratebelow50beats/minANS:CNa+nitroprussideisapotentvasodilatorandthemajoradverseeffectisseverehypotension.5.A pt who has chronic HF tells the nurse, “I was fine when I went to bed, but I woke up in themiddleofthenightfeelinglikeIwassuffocating!”Howshouldthenursedocumentthisfinding?a.Orthopneab.Pulsusalternansc.Paroxysmalnocturnaldyspnead.AcutebilateralpleuraleffusionANS:CParoxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependentbody areaswhen the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation.Pulsus alternans is the alteration of strong and weak peripheral pulses during palpation. Orthopneaindicatesthatthepatientisunabletolieflatbecauseofdyspnea.Pleuraleffusionsdevelopoveralongertime period.6.Whichstatementbyaptnewlydxw/HFindicatestothenursethatteachingwaseffective?a.“Iwilltakefurosemide(Lasix)everydayjustbeforebedtime.”b.“IwillusethenitroglycerinpatchwheneverIhavechestpain.”c.“IwilluseanadditionalpillowifIamshortofbreathatnight.”d.“Iwillcalltheclinicifmyweightgoesup3poundsinaweek.”ANS:D7.Whenteachingptw/HFona2000-mgNa+diet,whichfoodsshouldthenurserecommendlimiting?a.Chickenandeggsb.Cannedandfrozenfruits

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c.Yogurtandmilkproductsd.FreshorfrozenvegetablesANS:CYogurtandmilkproducts(e.g.,cheese)naturallycontainasignificantamountofNa+8.ThenurseplansDCteachingforptw/chronicHFwhohasRxfordigoxin(Lanoxin)andhydrochlorothiazide.Whichinstructionshouldthenurseinclude?a.Limitdietarysourcesofpotassium.b.Takethehydrochlorothiazideatbedtime.c.Notifythehealthcareproviderifnauseadevelops.d.Takethedigoxinifthepulseisbelow60beats/min.ANS:CNauseaisasymptomofdigoxintoxicityandshouldbereportedsothattheprovidercanassessthepatientfor toxicityandadjustthe digoxindose,if necessary.9.Whileadmitting82yow/acutedecompensatedHFtothehospital,RNlearnsthatptlivesalone&sometimesconfuses“waterpill”w/“<3pill.”WhatshouldRNincludeinDCplan?a.Consultwithapsychologist.b.Transfertoalong-termcarefacility.c.Referraltoahomehealthcareagency.d.Arrangementsforaround-the-clockcare.ANS:C10.FollowinganAMI,apreviouslyhealthy60yodevelopsHF.WhatmedtopicshouldRNanticipateincludingin discharge teaching?a.-Adrenergicblockersb.Calciumchannelblockersc.Digitalisandpotassiumtherapyregimend.Angiotensin-convertingenzyme(ACE)inhibitorsANS:DACEinhibitortherapyiscurrentlyrecommendedtopreventthedevelopmentofHFptswhohavehad an MI & as a 1st-line thx for pts w/ chronic HF. Digoxin thx for HF is no longer considered a first-linemeasure, and digoxin is added to tx protocol when thx w/ other drugs such as ACE-inhibitors, diuretics,and-adrenergic blockersisinsufficient.11.53yow/stageDHF&type2DMasksRNif<3transplantisanoption.Accurateresponse?a.“Yourheartfailurehasnotreachedtheendstageyet.”b.“Youcouldnotmanagethemultiplecomplicationsofthatsurgery.”c.“Thesuitabilityofahearttransplantforyoudependsonmanyfactors.”d.“Becauseyouhavediabetes,youwouldnotbeahearttransplantcandidate.”ANS:CIndicationsforahearttransplantincludeend-stageheartfailure(stageD),butotherfactorssuchascopingskills/familysupport/ptmotivationtofollowrigorousposttransplantregimenareconsidered.12.WhichdxtestmostusefultoRNindeterminingwhetherptadmittedw/acuteSOBhasHF?a.Serumtroponinb.Arterialbloodgasesc.B-typenatriureticpeptide(BNP)

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d.12-leadelectrocardiogramANS:C(BNP is secreted whenventricular pressures ↑, as they do w/ HF. ↑ BNP indicates a probable orveryprobabledxofHF.A12-leadECG,ABG,andtroponinmayalsobeusedindeterminingthecausesoreffectsof HFbutare notasclearly dxof HFasBNP.13.WhichactionshouldthenurseincludeinPOCforaptadmittedwithacutedecompensatedheartfailure(ADHF)whoisreceivingnesiritide (Natrecor)?a.Monitorbloodpressurefrequently.b.Encouragepatienttoambulateinroom.c.Teachpatienttodrinkatleast3litersoffluiddaily.d.Titratenesiritidedosedownslowlybeforestopping.ANS:ANesiritide is a potent arterial and venous dilator, and the major adverse effect is hypotension.Becausetheptislikelytohaveorthostatichypotension,theptshouldnotbeencouragedtoambulate.Nesiritidedoesnotrequiretitration.ExcessivehydrationcouldexacerbateADHF.14.Ptw/chronicHFhasaneworderforcaptopril12.5mgPO.Aftergivingthe1stdose&teachingptaboutthedrug,whichstatementbyptindicatesthatteachinghasbeeneffective?a.“Iplantotakethemedicationwithfood.”b.“Ishouldeatmorepotassium-richfoods.”c.“IwillcallforhelpwhenIneedtogetuptousethebathroom.”d.“Icanexpecttofeelmoreshortofbreathforthenextfewdays.”ANS:CCaptoprilcancausehypotension,especiallyaftertheinitialdose15.Ptwho’sjustbeenadmittedw/PEisscheduledtoreceivethefollowingmeds.Whichmedshouldnursequestion?a.captopril(Capoten)25mgb.furosemide(Lasix)60mgc.digoxin (Lanoxin) 0.125 mgd.carvedilol(Coreg)3.125mgANS:DAlthough carvedilol is appropriate for tx of chronic HF, it is not used for pts w/ acutedecompensatedHF(ADHF)becauseoftheriskofworseningHF.Theotherdrugsareappropriatefortheptw/ADHF.16.AptwhohaschronicHFisadmittedtotheEDw/severedyspneaandadry,hackingcough.Whichactionshouldthe nursetake 1st?a.Auscultatetheabdomen.b.Checkthecapillaryrefill.c.Auscultatethebreathsounds.d.Askaboutthepatient’sallergies.ANS:CThispt’sseveredyspneaandcoughindicatethatacutedecompensatedHF(ADHF)maybeoccurring.ADHFusuallymanifestsasPE,whichshouldbedetectedandtximmediatelytopreventongoinghypoxemia andcardiac/respiratory arrest.

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17.Aptw/chronicHFwhoistakingadiureticandanACEinhibitorandwhoisona↓-Na+diettellshomehealthnurseabouta 5lbwt↑inpast3days.Priority action?a.Teachthepatientaboutrestrictingdietarysodium.b.Assessthepatientformanifestationsofacuteheartfailure.c.Askthepatientabouttheuseoftheprescribedmedications.d.Havethepatientrecallthedietaryintakeforthepast3days.ANS:B5lbwt↑over3daysindicatesthatpt’schronicHFmaybeworsening.It’simportantthatptbeassessedimmediatelyforotherclinicalmanifestationsofdecompensation,suchaslungcrackles.18.AptintheintensivecareunitwhohasacutedecompensatedHF(ADHF)reportsseveredyspneaandisanxious,tachypneic,andtachycardic.SeveraldrugshavebeenRxforthept.Whichactionshouldthe nursetake 1st?a.GivePRNIVmorphinesulfate4mg.b.GivePRNIVdiazepam(Valium)2.5mg.c.Increasenitroglycerininfusionby5mcg/min.d.Increasedopamineinfusionby2mcg/kg/min.ANS:AMorphine improves alveolar gas exchange, improves cardiac output by reducing ventricularpreload and afterload, decreases anxiety, and assists in reducing the subjective feeling of dyspnea.Diazepammaydecreasepatientanxiety,butitwillnotimprovetheCOorgasexchange.Increasingthedopamine may improve cardiac output, but it will alsoincrease the heart rate and myocardial oxygenconsumption.Nitroglycerinwillimprovecardiacoutputandmaybeappropriateforthispatient,butitwillnotdirectlyreduceanxietyandwillnotactasquicklyasmorphinetodecreasedyspnea.19.Afterreceivingreporton4ptsadmittedtoaHFunit,whichptshouldthenurseassessfirst?a.Apatientwhoreporteddizzinessafterreceivingthefirstdoseofcaptopril.b.Apatientwhohasnew-onsetconfusionandrestlessnessandcool,clammyskin.c.Apatientwhoisreceivingoxygenandhascracklesbilaterallyinthelungbases.d.ApatientwhoisreceivingIVnesiritide(Natrecor),withabloodpressureof100/62.ANS:BThepatientwhohas“wet-cold”clinicalmanifestationsofheartfailureisperfusinginadequatelyandneedsrapidassessmentandchangesinmanagement.Theotherptsalsoshouldbeassessedas20.Whichassessmentfindinginapatientadmittedwithacutedecompensatedheartfailure(ADHF)requiresthe mostimmediate actionby the nurse?a.O2saturationof88%b.Weightgainof1kg(2.2lb)c.Heartrateof106beats/mind.Urineoutputof50mLover2hoursANS:A21.A pt who has HF has recently started taking digoxin in addition to furosemide (Lasix) andcaptopril.WhichfindingbythehomehealthRNisaprioritytocommunicatetotheHCP?a.Presenceof1+to2+edemainthefeetandanklesb.Palpable liver edge 2 cm below the ribs on the right sidec.Serumpotassiumlevel3.0mEq/Lafter1weekoftherapy

2022-2023 ATI RN Medical Surgical Exam with Answers (269 Solved Questions) - Page 16 preview image

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d.Weightincreasefrom120poundsto122poundsover3daysANS:Cdysrhythmiasandpotentiatetheactionsofdigoxin.Hypokalemiaalso↑riskfordigoxintoxicity22.AnoutptwhohaschronicHFreturnstotheclinicafter2weeksoftherapywithmetoprolol(ToprolXL).WhichassessmentfindingismostimportantforthenursetoreporttotheHCP?a.2+bilateralpedaledemab.Heartrateof52beats/minc.Reportofincreasedfatigued.Bloodpressure(BP)of88/42mmHgANS:DThe pt’s BP indicates that the dose of metoprolol may need to be ↓ because of hypotension.Bradycardiaisafrequentadverseeffectof-adrenergicblockade,thoughitmayneedtobemonitored23.A pt who is receiving dobutamine for the tx of acute decompensated HF (ADHF) has thefollowingnursinginterventionsincludedinthePOC.Whichactionwillbemostappropriateforthe RNtodelegate toanLPN?a.Teachthepatientthereasonsforremainingonbedrest.b.ChangetheperipheralIVsiteaccordingtoagencypolicy.c.Monitorthepatient’sbloodpressureandheartrateeveryhour.d.Titratethedobutaminetokeepthesystolicbloodpressure>90mmHg.ANS:C24.Afterreceivingchange-of-shiftreportonaHFunit,whichptshouldthenurseassessfirst?a.Patientwhoistakingcarvedilol(Coreg)andhasaheartrateof58.b.Patientwhoistakingdigoxinandhasapotassiumlevelof3.1mEq/L.c.Patientwhoistakingcaptoprilandhasafrequentnonproductivecough.d.Patientwhoistakingisosorbidedinitrate/hydralazine(BiDil)andhasaheadache.ANS:BPtw/↓K+level↑riskfordigoxintoxicityandpotentiallylife-threateningdysrhythmias.3.DYSRHYTHMIAS1.Whatshouldthenursemeasuretodeterminewhetherthereisadelayinimpulseconductionthroughthepatient’sventricles?a.Pwaveb.Qwavec.PRintervald.QRScomplexANS:DTheQRScomplexrepresentsventriculardepolarization.2.Thenurseneedstoquicklyestimatetheheartrateforapatientwitharegularheartrhythm.Whichmethodwillbefastesttouse?a.CountthenumberoflargesquaresintheR-Rintervalanddivideby300.b.Printa1-minuteelectrocardiogram(ECG)stripandcountthenumberofQRScomplexes.

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