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Intermediate MED SURG ATI (Questions and Answers)

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Intermediate MED SURG ATI (Questions and Answers)

INTERMEDIATE MED SURG ATI 1. Nurse is evaluating a client who had a cardiac catheterization with a left antecubital insertion site. Which of the following pulses should the nurse palpate? a. Radial pulse in R arm b. Brachial pulse in R arm c. Radial pulse in L arm d. Brachial pulse in L arm 2. Nurse caring for client who has atrial fibrillation and receives Digoxin daily. Before administering this medication, which of the following actions should the nurse take? a. Weigh client b. Offer client a light snack c. Measure client’s apical pulse d. Measure client’s blood pressure 3. Nurse caring for client 4 hours following cardiac catheterization. Which of the following actions should nurse take? a. Keep affecte leg slightly flexed b. Have client lie flat in bed c. Keep client NPO for 4 hours d. Elevate head of bed 45 degrees 4. Nurse is caring for client who just had a cardiac catheterization. Which of the following nursing interventions should nurse include in client’s plan of care? (SELECT ALL) a. Keep client’s hip & leg extended b. Check peripheral pulses in affected extremity c. Measure client’s vital signs every 4 hours → should be frequent (every 15 minutes) d. Place client in high-fowler’s position → should be flat in bed e. Have client remain in bed up to 4 hours 5. Nurse is providing teaching for client who has new diagnosis of angina pectoris. The nurse should give the client which of the following information about anginal pain? a. Exertion & anxiety can trigger the pain b. The pain persists with rest & organic nitrates c. The pain often radiates to jaw or back d. Pain usually lasts longer than 20 minutes 6. Nurse is assessing a client who has atrial fibrillation. Which of the following pulse characteristics should nurse expect? a. Irregular b. Bounding c. Not palpable d. Slow 7. Nurse is providing teaching for client who is on diuretic therapy & has new prescription for Potassium Chloride (KCL) 20 mEq extended release PO daily. Which of the following instructions should the nurse provide about the new prescription? a. Take extended release tablets on empty stomach b. Take the tablets whole c. Expect urinary output to decrease while on medication d. Add an antacid if medication causes indigestion 8. Nurse is caring for client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. Client asks if medication can be crushed to make it easier to swallow. Which response should nurse provide? a. “Crushing would release medication all at once, rather than over time” b. “Crushing is unsafe, it destroys the ingredients in medication” c. “Crushing the medication might cause stomach ache or indigestion” d. “Crushing medication is a good idea, it can mix well in ice cream” 9. Nurse is teaching client who has new prescription for aspirin to prevent cardiovascular disease. Which instruction should nurse include in teaching? a. Monitor for tinnitus b. Expect stools to turn black c. Take tablets on empty stomach d. Anticipate tablets to smell like vinegar 10. Nurse is performing ECG on client who is experiencing chest pain. Which of the following statements should nurse make? a. “Test will be complete in 30-60 minutes” b. “I will need to apply electrodes to chest & extremities” c. “Radioactivity from dye lasts only a few hours” d. “You might feel slight tingling while test is being done” 11. Nurse in ED is caring for client who took 3 Nitroglycerin tablets sublingual for chest pain. Client reports relief from chest pain but now is experiencing a headache. Which statement should nurse make? a. “A headache indicates tolerance to medication” b. “A headache is likely due to anxiety about chest pain” c. “A headache is an expected adverse effect of the medication” d. “A headache is an indication of an allergy to the medication” 12. Nurse is providing teaching for client who has hypertension & a prescription change from Metoprolol to Metoprolol/Hydrochlorothiazide. Which of the following statements by client indicates understanding of teaching? a. “Extra letters after the name of medication means it is a stronger dose” b. “I will not have to do anything different because it is the same medication” c. “Now i will not have to diet to lose weight” d. “With the new medication, I should experience fewer side effects” 13. A home health nurse is making a home visit to a client who takes a daily diuretic for heart failure. Which manifestation should nurse identify as indicating client is hypokalemic? a. Dyspnea b. Fatigue → due to muscle weakness that comes with hypokalemia c. Pitty edema d. Oliguria 14. Nurse is providing teaching to client who has new prescription for Verapamil for angina. Which instruction should nurse include? a. “You can expect swelling of ankles” b. “Increase your daily intake of dietary fiber” → reduce risk of constipation from medication c. “Do not take this medication on an empty stomach” d. “Limit your fluid intake to meal times” 15. Nurse is caring for client who has atrial fibrillation and is receiving Heparin. Which of the following findings is the nurse’s priority? a. Client experiences sudden weakness of one arm & leg (possible blood clot/stroke) b. Client’s ECG tracing shows irregular heart rate w/o P waves c. Client’s urine output is cloudy & odorous d. Client has an aPTT of 80 seconds 16. Nurse is preparing to administer Potassium Chloride to a client who is receiving diuretic therapy. Nurse reviews client’s serum potassium level results and discovers the client’s potassium level is 3.2. Which action should nurse take? a. Call the lab to verify b. Omit the KCL & document it wasn’t given c. Hold the prescribed dose and call doctor d. Give the ordered KCL as prescribed 17. Nurse is providing discharge teaching to client who has an implantable cardioverter/defibrillator (ICD). which information should nurse include? a. Client should hold cell phone on side opposite ICD b. Client can carry his ICD in a small pocket c. Client cannot travel by air due to security screening d. Client should avoid the use of small electric devices 18. Nurse providing instruction to new nurse about caring for clients who are receiving diuretic therapy to treat heart failure. Nurse should explain which of the following medications puts client at risk for both hyperkalemia & hyponatremia? a. Furosemide b. Hydrochlorothiazide c. Spironolactone → potassium-sparing diuretic that blocks the effects of aldosterone in renal tubes, causing loss of sodium & water & retention of potassium d. Metolazone 19. Nurse caring for client who develops a vascular fibrillation rhythm. Client is unresponsive, pulseless, and apneic. Which action is nurse’s priority? a. Amiodarone administration b. Airway management c. Epinephrine administration d. Defibrillation 20. Client who has coronary artery disease tells nurse he is afraid of dying from a heart attack. Which response should nurse make? a. Tell me more about these fears of dying b. Of course you won’t die, at least not immediately c. I recommend you exercise daily & avoid smoking d. Perhaps you should discuss this with your doctor 21. Nurse caring for client who is on Warfarin therapy for atrial fibrillation. Client’s INR is 5.2. Which medication should nurse prepare to administer? a. Epinephrine b. Atropine c. Protamine d. Vitamin K → reverses effects of Warfarin 22. Nurse in provider’s clinic is assessing a client who takes sublingual Nitroglycerin for stable angina. Client reports getting a headache each time he takes the medication. Which statement should nurse make? a. Take only 1 dose of it to reduce risk of headaches b. There’s nothing that can be done to relieve it c. We will ask provider to prescribe a different medication for you d. Try taking mild analgesic to relieve the headache 23. Nurse asks client who is about to have cardiac catheterization about any allergies. Client states, “I always get a rash when I eat shellfish.” which is priority nursing action? a. Ask client if any other foods cause this reaction b. Notify the provider of allergy → iodine in contrast dye also contains shellfish c. Attach a wrist band indication allergy d. Notify the dietary department of allergy 24. Nurse is reviewing laboratory results of client who has atrial fibrillation and is taking Warfarin. Which results should nurse notify the provider about? a. Hct 44% b. Hgb 16 g/dL c. PT 45 seconds → expected range is 11-12.5 seconds d. Platelets 190,000/mm 25. Nurse is teaching client who has new prescription for transdermal Nitroglycerin to treat angina pectoris. Which instruction should nurse include? a. Apply new patch when chest pain is experienced b. Apply new patch once a week c. Apply patch to same location as previously d. Apply patch in the morning → should be applied in the morning and left for 12-14 hours, then removed in the evening 26. Nurse is teaching the partner of a client who had an acute myocardial infarction (MI) about reason blood was drawn from client. Which statement should nurse make regarding cardiac enzymes? a. Test will enable the provider to determine the heart structure & mobility of heart valves b. Cardiac enzymes will identify the location of the MI c. Tests help determine degree of damage to heart tissues d. Cardiac enzymes assist in diagnosing presence of pulmonary congestion 27. Nurse is caring for client who is scheduled for an exercise stress test. Which comment by client would indicate further teaching? a. “I will not smoke prior to test” b. “I’ll take my heart medication in the morning of the test” c. “I’ll skip my coffee in the morning” d. “I’ll get 8 hours of sleep the night before” 28. Nurse is caring for client who has central venous catheter and suddenly develops chest pain, dyspnea, dizziness, & tachycardia. Nurse suspects air embolism & clamps catheter immediately. Which other action should nurse take? a. Place client on L side in Trendelenburg position b. Remove catheter c. Prepare chest tube insertion d. Replace the infusion system 29. Nurse is reviewing health history for client who has angina pectoris & prescription for Propranolol Hydrochloride PO 40 mg twice daily. Which finding in history should nurse report to provider? a. Hx of hypothyroidism b. Hx of migraine headaches c. Hx of hypertension d. Hx of bronchial asthma 30. Nurse teaching newly licensed nurse about evaluating cardiac rhythm. Which option should nurse identify as P wave in ECG? Answer: first box on the left side 31. Nurse is caring for client who reports a new onset of severe chest pain. Which action should nurse take to determine if client is having an MI? a. Check BP b. Determine if pain radiates to left arm c. Auscultate heart tones d. Perform a 12-lead ECG 32. Nurse is preparing to administer Verapamil by IV bolus to client who is having cardiac dysrhythmias. Which adverse effect should nurse monitor? a. Muscle pain b. Hypotension → Verapamil is a calcium channel blocker, can be used to control supraventricular tachyarrhythmias; also decreases BP and acts as coronary vasodilator & antianginal agent c. Ototoxicity d. Hyperthermia 33. Nurse is assessing an older adult client who is receiving Digoxin. Nurse should recognize that which finding is a manifestation of Digoxin toxicity? a. Jaundice b. Anorexia c. Photosensitivity d. Ataxia (lack of muscle coordination) 34. Nurse is caring for client who had an MI. Upon first visit to cardiac rehabilitation, tells the nurse he doesn’t understand why he needs to be there because there is nothing more to do, the damage is done. Which is the correct response? a. “Cardiac rehab cannot undo the damage, but it can help you get back to your previous level of activity safely” b. “Exercise is good for you & good for your heart” c. “It’s not unusual to feel this way at first, but once you learn, you’ll enjoy it” d. “Your doctor is the expert here, and i’m sure he would say it’s best” 35. Nurse is teaching client who has angina pectoris about starting therapy with SL Nitroglycerin tablets. Nurse should include which instruction about how to take? a. Take 1 tablet at first indication of chest pain b. Take 1 tablet every 15 minutes during an acute attack c. Take medication with 8 ounces of water d. Take medication after each meal & at bedtime 36. Nurse on telemetry unit is caring for client who has unstable angina and is reporting chest pain with a severity of 6/10. Nurse administers 1 SL tablet. After 5 minutes, client states his chest pain is now severity of 2. Which action should nurse take? a. Call RRT (rapid response team) b. Administer another tablet c. Obtain an ECG d. Initiate peripheral IV 37. Nurse is reinforcing teaching with client regarding reduction of risk factors for coronary artery disease. Which of the following statements by client indicates an understanding? (SELECT ALL) a. I need to monitor my weight b. I am limiting my intake of fast foods c. I will stop consuming alcohol d. I should limit my exercise e. I must stop smoking 38. Nurse is assessing client who had L femoral cardiac angiography. Identify where the nurse will palpate to assess the most distal pulse on affected side. Answer: L pedal pulse 39. A nurse at a provider’s office receives a phone call from a client who reports nausea & unrelieved chest pain after taking tablet 5 minutes ago. Which of the following is an appropriate response by nurse? a. Tell the client to take an antacid b. Instruct client to call 911 c. tell client to take another tablet in 15 minutes d. Advise the client to come to office 40. Nurse is caring for client who has an elevated Potassium level and is on a cardiac monitor. Nurse is aware that hyperkalemia may be associated with changes in T-wave. Which point represents the T-wave? Answer: last wave on the right side (end) 41. A client who has history of MI is prescribed aspirin 325 mg. The nurse recognizes that aspirin is given due to which action of the medication? a. Antipyretic b. Analgesic c. Anti-inflammatory d. Antiplatelet aggregate → decrease likelihood of blood clotting 42. A nurse is preparing to administer Digoxin to a client who has heart failure. Which action is appropriate? a. Withholding medication if HR is above 100 b. Measuring apical pulse rate for 30 seconds c. Evaluating the client for nausea, vomiting, & anorexia d. Instructing client to eat foods that are low in potassium 43. Nurse is interpreting the ECG strip of a client who has bradycardia. Which cardiac components should nurse identify as role of the P-wave? a. Atrial depolarization b. Ventricular depolarization c. Early ventricular repolarization d. Slow repolarization of ventricular Purkinje Fibers 44. Nurse is caring for client who came to ED reporting chest pain. The provider suspects an MI. while waiting for troponin levels report, client asks what this blood test will show. Which explanation should nurse provide? a. Troponin indicates damage to brain, heart, & skeletal muscle tissues b. Troponin is lipid whose levels reflect the risk for coronary heart disease c. Troponin is heart muscle protein that appears in blood stream where there is damage to the heart d. Troponin is protein that helps oxygen throughout the body 45. A nurse is teaching a client who takes aspirin daily for coronary artery disease about herbal supplements. Nurse should instruct the client that which herbal supplement may interact with aspirin adversely. a. Feverfew b. Aloe vera c. Flaxseed d. Cranberry juice

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