2023-2024 ATI NGN Adult Medical Surgical Proctored Exam with Answers (60 Solved Questions)

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NGN 2023/2024AdultMedicalSurgicalATIProctoredExamGRADED A+=Q u esti o n9 0 l o a ded ra t i o n a lsp r o v i d edQuestion:90 of90CORRECTFLAGTimeRemaining:00:38:42PauseRemaining:00:05:00PAUSEA nurse is caring for a client who has atopic dermatitis and a prescription for triamcinoloneointment. The nurse should assess the client to monitor for which of thefollowing adverseeffects?IncreasedpigmentationTopicalglucocorticoidtherapycancausetheadverseeffectofhypopigmentation.LocalizedhairlossLong-term glucocorticoid therapy can cause hypertrichosis, or excessive hair growth,especiallyonthe facialarea.Thinningofthe skinMYA NSWERThinning of the skin and delayed healing are adverse effects of topical glucocorticoidpreparations. The client should only apply the ointment to dry patches of the skin becausetopical steroids can cause atrophy of the dermis and epidermis, which can result inthinningofthe skin.Increasedsensitivitytothe sunThe nurse should instruct the client to avoid excessive sun exposure when taking topicalfluticasone;however, triamcinoloneointmentdoesnotcausephotosensitivity.RNVATIAdultMedicalSurgical2019CLOSEQ u esti o n8 9 l o a ded ra t i o n a lsp r o v i d edQuestion:89 of90CORRECTTimeRemaining:00:37:45

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NGN 2023/2024AdultMedicalSurgicalATIProctoredExamGRADED A+=FrothysputumFLAGPauseRemaining:00:05:00PAUSEA nurse is assessing a client who has left-sided heart failure. Which of the following findingsshould thenurse identifyasamanifestation ofleft-sidedheartfailure?DependentedemaThe nurse should identify thatdependent edema is a manifestation of right-sided heartfailure due to right ventricular failure and fluid retention from pressure building up in thevenoussystem.JugulardistentionThe nurse should identify that jugular vein distention is amanifestation of right-sided heartfailure due to right ventricular failure and fluid retention from pressure building up in thevenoussystem.WeightgainThe nurse should identify that weight gain is a manifestation of right-sided heart failuredue toright ventricular failure and fluid retention from pressure building up in the venoussystem.MYA NSWERThe nurse should identify that frothy sputum, dyspnea, and wheezing are manifestations ofleft-sided heart failure.Treatment includes fluid restriction and diuretics to decreasepreload and reduce pulmonary congestion. Pink-tinged frothy sputum can be an earlyindication of pulmonary edema and can be life-threatening. Therefore, the nurse shouldnotifythe provider immediately.RNVATIAdultMedicalSurgical2019CLOSEQ u esti o n8 8 l o a ded ra t i o n a lsp r o v i d edQuestion:88 of90CORRECT

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NGN 2023/2024AdultMedicalSurgicalATIProctoredExamGRADED A+=RespiratoryalkalosisFLAGTimeRemaining:00:37:30PauseRemaining:00:05:00PAUSEAnurse is caring for a client who is experiencing anxiety as well as numbness and tingling of thelips andfingers. Theclient's ABGsare:pH7.48,PCO230mmHg,HCO3-24mEq/L,PaO285mmHg. Which of the following acid-base imbalances should the nurseidentify that the client isexperiencing?MYA NSWERThis pH is alkaline (increased) and the PCO2is decreased, representing alveolarhyperventilation and resultant respiratory alkalosis.Respiratory acidosisThis pH is alkaline (increased) and the PCO2is decreased. A decreased pH and an increasedPCO2indicate respiratory acidosis.Metabolic alkalosisThis HCO3-24 mEq/L is within the expected range of 21 to 28 mEq/L and the pH is alkaline(increased). An increased pH and HCO3-indicate metabolic alkalosis.Metabolic acidosisThis HCO3-24 mEq/L is within the expected range of 21 to 28 mEq/L and the pH is alkaline(increased). A decreased pH and HCO3-indicate metabolic acidosis.RNVATIAdultMedicalSurgical2019CLOSEQ u esti o n8 7 l o a ded ra t i o n a lsp r o v i d edQuestion:87 ofCORRECTFLAGTimeRemaining:00:37:22PauseRemaining:00:05:00PAUSEA nurse is assessing a client who has Cushing'ssyndrome. Which of the following findingsshould thenurseexpect?Vitiligo

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NGN 2023/2024AdultMedicalSurgicalATIProctoredExamGRADED A+=OsteoporosisApearly,waxynoduleVitiligo is the loss of pigment from areas of a client's skin, causing irregular, white patches.Vitiligois a manifestation ofadrenal-glandhypofunction.MYA NSWEROsteoporosis is a common finding with Cushing's syndrome. Bones become thinner as aresultofminerallossandnitrogendepletion,andtheriskforfractures increases.MyxedemaA client who has hypothyroidism candevelop myxedema that causes mucinous cellularedemaaroundtheeyes,across theupperback,andinthehandsandfeet.HeatintoleranceA client who has hyperthyroidism can develop heat intolerance, along with an increase insweating.RNVATIAdultMedicalSurgical2019CLOSEQ u esti o n8 6 l o a ded ra t i o n a lsp r o v i d edQuestion:86of90CORRECTFLAGTimeRemaining:00:37:13PauseRemaining:00:05:00PAUSEA nurse is inspecting the skin of a clientwho has basal cell carcinoma. The nurse should identifywhichofthefollowinglesioncharacteristicsonthe client'sskin?MYA NSWERA client who has basal cell carcinoma has a nodular lesion with well-definedborders and apearly or waxy appearance, resulting from overexposure to the sun, especially on the face,head,andneck.An irregularborderonavariegated-coloredlesion

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NGN 2023/2024AdultMedicalSurgicalATIProctoredExamGRADED A+=A client who has melanoma has a lesion with irregular borders and variegated colors ofred, white, andblue,most oftenon theupperbackorlowerlegs.Afirm,nodular,crusty,orulceratedlesionA client who has squamous cell carcinoma has a firm, nodular, and crusty lesion with anulcerated center, resulting from sunexposure, chronic irritation, burns, or irradiation totheskin.A weepingvesicleAclientwhohasherpeszosterhasweeping,blister-typelesions.RNVATIAdultMedicalSurgical2019CLOSEQ u esti o n8 5 l o a ded ra t i o n a lsp r o v i d edQuestion:85 of90CORRECTFLAGTimeRemaining:00:37:02PauseRemaining:00:05:00PAUSEA nurse is assessing a client who has hypocalcemia. In which of the following areas should thenurse tap on the client's face todetect the presence of Chvostek's sign? (You will find hot spotstoselectintheartworkbelow.Selectonlythehotspotthatcorrespondstoyouranswer.)

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NGN 2023/2024AdultMedicalSurgicalATIProctoredExamGRADED A+=A is correct.The nurse should tap the client's cheek just in front of theear and below thezygomatic arch. The client who has hypocalcemia will display a Chvostek's sign, which is atwitchingofthe facial muscle.B is incorrect.The nurse should apply upward pressure at the supraorbital ridge, belowtheeyebrow,toassessfortendernessandinflammation ofthefrontalsinuses.C is incorrect.The nurse should palpate the jaw and mastoid muscle of a client who hastemporomandibular joint dysfunction. This can be caused by misaligned teeth, arthritis, orgrinding of the teeth.With palpation, the nurse might feel a click, pop, or grating sensationwhentheclientopens orcloses the jaw.

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NGN 2023/2024AdultMedicalSurgicalATIProctoredExamGRADED A+=LowurinespecificgravityRNVATIAdultMedicalSurgical2019CLOSEQ u esti o n8 4 l o a ded ra t i o n a lsp r o v i d edQuestion:84 of90CORRECTFLAGTimeRemaining:00:36:55PauseRemaining:00:05:00PAUSEA nurse in an emergency department is assessing a client who is overusing prescribed diureticsand has a sodium level of 127 mEq/L. Which of thefollowing laboratory findings should thenurseexpect?HighlipaseA high lipase level is associated with pancreatic dysfunction or renal failure and is not anexpectedfindingwith hyponatremiaordehydration.MYA NSWERA client who has hyponatremia as a result of diuretic overuse has a low urine specificgravity. The increased excretion of water alters the ratio of particulate matter, whichaffectsthe specific gravity.LowhemoglobinA client who isdehydrated as a result of diuretic overuse can have an elevated hemoglobinlevelbecauseofthedifference inratiobetweenintravascularfluidandbloodcells.Highcreatinekinase-MB(CK-MB)An elevated CK-MB level indicates a myocardial infarction andis not an expected findingwithhyponatremia.RNVATIAdultMedicalSurgical2019CLOSEQ u esti o n8 3 l o a ded ra t i o n a lsp r o v i d edQuestion:83 of90

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NGN 2023/2024AdultMedicalSurgicalATIProctoredExamGRADED A+=Reviewthedailyschedulewiththeclienteverymorning.INCORRECTFLAGTimeRemaining:00:36:47PauseRemaining:00:05:00PAUSEAhomehealthnurseisassistingaclient withplanningcarefor afamilymemberwhohasAlzheimer'sdisease.Which ofthefollowinginstructionsshouldthenurse include?Removeclutterfromroomsandhallways.Thenurse should instruct the family member to remove clutter from rooms and hallwaysso the client is able to walk without the risk of falling or tripping over objects. Later in thedisease,theclientcanexperienceseizures,soclutteredareascouldbearisktotheclient.Placeamonthlycalendarintheclient'sroom.MYA NSWERThe nurse should instruct the family member to place a single-date calendar in the client'sroom. A monthly calendar can be overwhelming and confusing to a clientwho hasAlzheimer'sdisease.Useconfrontationtomanagetheclient'sbehavior.The nurse should instruct the family member to redirect the client by starting anotheractivity when the client begins to act out or becomes overstimulated. Redirecting theclientmighthelp themgain focus.The nurse should instruct the family member to use short, simple sentences whenexplaining an activity to the client. The explanation should be doneimmediately before theactivitytoaidtheclient'smemoryandabilitytofollowdirections.RNVATIAdultMedicalSurgical2019CLOSEQ u esti o n8 2 l o a ded ra t i o n a lsp r o v i d edQuestion:82 of90CORRECTTimeRemaining:00:36:39

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NGN 2023/2024AdultMedicalSurgicalATIProctoredExamGRADED A+=RefractoryhypoxemiaFLAGPauseRemaining:00:05:00PAUSEA nurse is caring for a client who has developed acute respiratory distress syndrome (ARDS).Whichofthefollowingfindingsshouldthenurseidentifyasamanifestationofthissyndrome?Anaudiblepleuralfriction rubA client who has a pulmonary embolism can have a pleural friction rub along withtachypnea, tachycardia, dyspnea, and sudden, sharp chest pain. However, a pleural frictionrubis not a manifestation ofARDS.TrachealdeviationfromthemidlineA client who has a tension pneumothorax can have tracheal deviation with dyspnea,tachycardia, and tachypnea. On auscultation, breath sounds over the area of thepneumothorax are decreased or absent. However,tracheal deviation is not a manifestationofARDS.MYA NSWERARDS is a systemic inflammatory response to trauma, sepsis, burns, pancreatitis, and bloodtransfusions, when excess lung fluid dilutes surfactantactivity in the lungs. A client whohas ARDS has refractory hypoxemia, which is hypoxemia that does not improve withoxygen therapy. Extensive pulmonary edema evident on a chest x-ray is a manifestation ofARDS.BloodyexpectorantwhencoughingA client who has lung cancer or laryngeal trauma can have hemoptysis. However, bloodyexpectorantis not a manifestationofARDS.RNVATIAdultMedicalSurgical2019CLOSEQ u esti o n8 1 l o a ded ra t i o n a lsp r o v i d edQuestion:81 of90CORRECT

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