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ATI MEDICAL SURGICAL PROCTORED EXAM 2023 WITH NGN QUESTIONS AND CORRECT ANSWERS 100% Top Score
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ATI MEDICAL SURGICAL PROCTORED EXAM 2023 WITH NGN QUESTIONS AND CORRECT ANSWERS 100% Top Score
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ATI MEDICAL SURGICAL PROCTORED EXAM 20231. A nurse is reviewing information about the Health Insurance Portability and Accountability Act (HIPAA) with a
newlylicensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further
teaching?
A. "Information about a client can be disclosed to family members at any time."
Rationale: This statement reflects a need for further teaching. Privacy relates to the client's rights
over the use and disclosure of his or her own personal health information.
B. "HIPAA established regulations of individually identifiable health information in verbal, electronic, or
writtenform."
Rationale: This statement reflects an understanding of HIPAA. All health care organizations that use
electronic transactions and code sets, such as health care claims and claim payments, must
comply with HIPAA standards.
C. "A client's address would be an example of personally identifiable information."
Rationale: This statement reflects an understanding of HIPAA. Identifiers for the information include a
client's name, address, phone number, driver's license number, and so forth.
D. "HIPAA is a federal law, not a state law."
Rationale: This statement reflects an understanding of HIPAA, which is a federal law that was passed
in1996.
2. A nurse is preparing to perform hand hygiene. Which of the following actions should the nurse take?
A. Adjust the water temperature to feel hot.
Rationale: Using warm, instead of hot, water will help protect the skin by minimizing loss of the
protective oil on the skin. This will help maintain the integrity of the skin.
B. Apply 4 to 5 mL of liquid soap to the hands.
Rationale: The nurse should apply 4 to 5 mL of liquid soap to the hands to ensure an adequate
amount isavailable to produce lather and kill microorganisms.
C. Hold the hands higher than the elbows.
Rationale: The nurse should hold the hand lower than the elbows when washing the hands under
runningwater so that the water flows from the more contaminated area (the arms) to the
cleaner area (hands and fingers.)
D. Rub hands and arms to dry.
Rationale: The nurse should use a paper towel to pat the hand and arm dry without rubbing
vigorously.
Repeated rubbing of moist skin can lead to chapping and skin breakdown.
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,3. A nurse is preparing to administer three liquid medications to a client who has an NG feeding tube with
continuousenteral feedings. Which of the following actions should the nurse take?
A. Mix the three medications together prior to administering.
Rationale: The nurse should administer each medication separately and flush the tube with 15 to 30
mL ofsterile water to ensure the client receives the entire dose.
B. Dilute each medication with 10 mL of tap water.
Rationale: If the nurse needs to further dilute the medication because it is viscous, the nurse should
only use sterile water because tap water can contain contaminants that can adversely interact
withthe medication.
C. Maintain the head of the bed in a flat position for 30 min following medication administration.
Rationale: The nurse should ensure the head of the bed is elevated to at least 30° when a client is
receiving enteral feedings and also following medication administration through an enteral tube.
D. Flush the NG feeding tube with 30 mL of water immediately following medication administration
Rationale: The nurse should flush the NG feeding tube with 15 to 60 mL of sterile water
following medication administration to ensure the feeding tube is cleared of the
medications.
4. A nurse is administering nasal decongestant drops for a client. Which of the following actions should the
nursetake?
A. Tell the client to blow her nose gently before the instillation.
Rationale: Prior to instillation, the nurse should instruct the client to blow her nose gently. This action
will help remove any secretions or crusts that could interfere with the distribution and
absorption ofthe medication.
B. Assist the client to a side-lying position.
Rationale: The nurse should assist the client to lie supine for a nasal instillation.
C. Hold the dropper 2 cm (1 in) above the naris.
Rationale: The nurse should hold the dropper 1 cm (1/2 in) above each naris before instilling the drops.
D. Instruct the client to stay in the same position for 2 min.
Rationale: The client should stay in the same position for 5 min to make sure the drops do not run out
when the she sits or stands up.
5. A nurse is performing tracheostomy care for a client and suctioning to remove copious secretions. Which of
thefollowing actions should the nurse take?
A. Suction two to three times with a 60-second pause between passes.
Rationale:
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, Copious secretions may require several passes of the suction catheter. An interval of
60seconds should be allowed between passes to prevent hypoxia.
B. Perform chest physiotherapy prior to suctioning.
Rationale: This intervention mobilizes secretions but does not remove them.
C. Lubricate the suction catheter tip with sterile saline.
Rationale: This intervention has no effect on the removal of secretions.
D. Hyperventilate the client on 100% oxygen prior to suctioning.
Rationale: This intervention has no effect on the removal of secretions.
6. A newly licensed nurse is applying prescribed wrist restraints on a client. Which of the following actions should
thenurse take?
A. Secure the restraints using a quick-release tie.
Rationale: The nurse should secure the restraints using a quick-release tie for easy removal in an
emergency.
B. Ensure four fingers fit under the restraints to prevent constriction.
Rationale: The nurse should prevent constriction by inserting two fingers under the restraints. The
restraintmight be ineffective if the nurse can insert four fingers under it.
C. Secure the restraints to the lowest bar of the side rail.
Rationale: The nurse should secure the restraints to an area of the bed frame that moves with the
clientwhen repositioning, such as raising and lowering the head of the bed. The nurse
should not secure the restraints to the side rail.
D. Anticipate removing the restraints every 4 hr.
Rationale: The nurse should remove the restraints at least every 2 hr or more frequently according
tofacility policy.
7. The family of an older adult client brings him to the emergency department after finding him wandering outside.
During the initial assessment, the nurse notes that the client flinches when she palpates his abdomen yet
respondsto questions only by nodding and smiling. Which of the following factors should the nurse identify as a
likely explanation for the client's behavior?
A. He is hard of hearing.
Rationale: If the client cannot hear the nurse, he would most likely communicate that.
B. Pain
Rationale: Clients who have pain can usually still provide assessment data.
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, C. Confusion
Rationale: Since the client was manifesting signs of confusion before coming to the emergency
departmentand currently seems unable to understand or respond to speech, the nurse should
determine that the client has confusion.
D. Language barrier
Rationale: Even if the client speaks a different language as the nurse, the family accompanied him.
Although the nurse should use a medical interpreter, the family should be able to provide
someinitial explanations of the facts leading to the visit.
8. A nurse is preparing a client for outpatient surgery. After the nurse inserts the IV catheter, the client reports pain
inthe insertion area. Which of the following actions should the nurse take?
A. Remove the catheter and insert another into a different site.
Rationale: It is possible that the catheter is up against a valve or near a nerve and is causing more
painthan an IV catheter insertion should. The nurse should remove the source of the pain
and establish peripheral IV access elsewhere.
B. Administer an analgesic PO.
Rationale: Before administering any medication for the client’s discomfort, the nurse should assess the
painand try to identify and eliminate its cause.
C. Request a prescription for placement of a central venous access device.
Rationale: A central venous access device is for long-term administration of various medications and
IVpreparations. Outpatient surgery is not an indication for this type of IV access.
D. Administer a local anesthetic.
Rationale: Before administering any medication for the client’s discomfort, the nurse should assess the
painand try to identify and eliminate its cause.
9. A client smoking in his bathroom has dropped a cigarette butt into a wastepaper basket, which begins to
smolder.Which of the following actions is the nurse’s priority?
A. Close the fire doors on the unit.
Rationale: Clients are at risk for injury because the smoke and fire could spread through open
doors; however, another action is the priority.
B. Activate the fire alarm.
Rationale: Clients are at risk for injury because the smoke and fire could spread without
emergencyservices intervention; however, another action is the priority.
C. Move any clients in the immediate vicinity.
Rationale:
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