ATI-AMS ATI Adult medical surgical Exam - Set 2 - Part 2

Correct Answer: I will keep my affected leg straight

After a femoral cardiac catheterization the client must keep the affected leg straight and remain on bed rest. This prevents bleeding and hematoma formation at the arterial puncture site while it begins to seal. Option a is incorrect because cardiac catheterization uses a mild sedative and local anesthetic, leaving the client awake and responsive. General anesthesia is not part of this procedure, so the client's expectation here reflects a misunderstanding of what to anticipate. Option b is incorrect because the client must be NPO for several hours before the procedure, not eat a full meal. Fasting reduces aspiration risk during sedation, making a pre-procedure meal exactly what should be avoided. Option d is incorrect because walking immediately would disturb the femoral puncture site and risk serious bleeding. Bed rest with the leg kept straight is required afterward, so getting up right away contradicts the safe recovery instructions.

Correct Answer: Notify the provider before the procedure

Atrial fibrillation of unknown duration requires several weeks of anticoagulation before cardioversion to prevent dislodging a clot. Lacking this therapy, the nurse should notify the provider because of the stroke and embolism risk. Option a is incorrect because going ahead without prior anticoagulation could shake loose an atrial clot, sending it to the brain or lungs. Proceeding as scheduled ignores the embolism danger that makes provider notification the correct step here. Option b is incorrect because atropine treats symptomatic bradycardia, not atrial fibrillation awaiting cardioversion. Giving it does nothing about the unaddressed clot risk, which is the real concern that should prompt the nurse to contact the provider. Option c is incorrect because oxygen is actually provided during cardioversion preparation, not withheld. The pressing issue is the missing weeks of anticoagulation, an embolism hazard that withholding oxygen would neither cause nor solve.

Correct Answer: Defibrillation with an unsynchronized shock

Ventricular fibrillation is a pulseless, chaotic rhythm treated with immediate unsynchronized defibrillation. The countershock stops all electrical activity so the sinus node can resume a perfusing rhythm, the appropriate emergency response. Option a is incorrect because synchronized cardioversion times the shock to the R wave and is used for organized rhythms like atrial fibrillation or VT with a pulse. Ventricular fibrillation has no organized R wave to synchronize with, so unsynchronized defibrillation is required. Option c is incorrect because atropine is the drug for symptomatic bradycardia, not for a lethal ventricular rhythm. Giving it would waste critical time in ventricular fibrillation, which demands an immediate defibrillating shock rather than a heart-rate medication. Option d is incorrect because a permanent pacemaker addresses chronic bradydysrhythmias and conduction failures, not an acute pulseless arrest. The client in ventricular fibrillation needs immediate defibrilla

Correct Answer: I will inform airport security screeners

A pacemaker can trigger airport security detectors, so the client should inform screeners and carry a device identification card. Notifying security ensures the handheld wand is not placed directly over the generator. Option a is incorrect because raising the arm above the shoulder during the first weeks can dislodge the pacemaker leads before they secure. The client should avoid this motion, making frequent overhead arm lifting the opposite of correct early activity. Option b is incorrect because an MRI scan is contraindicated for many pacemakers because the strong magnetic field can disrupt the device. The client must inform providers and avoid such fields, so assuming a scan is harmless reflects a misunderstanding. Option c is incorrect because the client should check the pulse daily at the same time, not just weekly, to detect a rate below the pacemaker's setting. Weekly checks are too infrequent to catch a malfunction promptly.

Correct Answer: Cardiac tamponade

A sudden drop in chest tube drainage after heavy output, with neck vein distention and clear lungs, suggests cardiac tamponade. Blood is accumulating around the heart instead of draining, compressing it and demanding emergency intervention. Option b is incorrect because a pneumothorax produces absent breath sounds and respiratory distress on the affected side, not clear lungs with a sudden drainage drop. The pattern described instead reflects blood collecting around the heart and impairing its filling. Option c is incorrect because a graft infection develops over days with fever, redness, and drainage at the incision, not an abrupt drainage stop with neck vein distention. The acute compressive picture here points clearly to tamponade instead. Option d is incorrect because pulmonary edema fills the lungs with fluid and causes crackles and frothy sputum, which contradicts the clear lungs noted here. The combination of distended neck veins and halted drainage signals tamponade rather than

Correct Answer: I will call for help if unrelieved

If chest pain persists a few minutes after the first sublingual nitroglycerin dose, the client should call emergency services. Unrelieved pain may signal a myocardial infarction, so prompt activation of emergency care is essential. Option a is incorrect because nitroglycerin is placed under the tongue to dissolve and absorb through the oral mucosa, not swallowed. Swallowing it with water would destroy its rapid sublingual action and delay relief of the anginal pain. Option c is incorrect because the recommendation is up to three doses at short intervals, then calling for help if the first dose fails. Taking many tablets before seeking aid would dangerously delay treatment of a possible infarction. Option d is incorrect because taking the tablet only after a meal ties relief to eating, but anginal pain can strike anytime. The client should stop, rest, and dose at the onset of pain, so this restriction dangerously delays treatment.

Correct Answer: I will report a low pulse rate

Metoprolol slows the heart rate, so the client should check the pulse and notify the provider when it falls below the parameter set by the provider. This precaution guards against excessive bradycardia from the beta-blocker. Option a is incorrect because ringing in the ears, or tinnitus, is a sign of aspirin toxicity, not an effect of metoprolol. Expecting this symptom from the beta-blocker confuses two different cardiac medications and their distinct adverse effects. Option b is incorrect because prothrombin time monitoring applies to warfarin, an anticoagulant, because metoprolol does not affect clotting. The relevant safety check for this beta-blocker is the pulse rate, making the clotting-time statement incorrect here. Option c is incorrect because metoprolol is taken on a scheduled basis to lower heart rate and blood pressure and reduce infarct size, not only for pain. Using it solely during pain misses its ongoing cardioprotective purpose after a heart attack.

Correct Answer: Myocardial infarction

Prolonged pain that resists rest and nitroglycerin, with nausea and diaphoresis, indicates a myocardial infarction. Unlike angina, infarction pain reflects ongoing tissue death and is typically relieved only by opioids. Option a is incorrect because stable angina is brought on by exertion and eases fairly quickly with rest or nitroglycerin. Pain that persists for an extended time and ignores those measures has moved beyond angina into infarction territory instead. Option b is incorrect because variant angina results from coronary artery spasm and, like other angina, responds to nitroglycerin. The prolonged, nitroglycerin-resistant pain with nausea and sweating described here fits a myocardial infarction rather than a spasm-related episode. Option d is incorrect because pleuritic chest pain worsens with breathing and is tied to the lungs, not to coronary ischemia. The cardiac features here, unrelieved prolonged pain with nausea and diaphoresis, point to infarction instead of a respirato

Correct Answer: Troponin T

Troponin T stays elevated the longest after cardiac injury, so it remains useful for confirming an infarction that happened as long as a couple of weeks earlier. The other markers return to baseline well before then. Option b is incorrect because myoglobin rises and falls very early, returning to normal within about a day of injury. So long after the suspected event it would read normal, making it useless for confirming an infarction this far in the past. Option c is incorrect because creatine kinase MB returns to baseline quickly after myocardial damage. Because it clears so soon, it cannot detect an event that occurred well before testing, unlike troponin T with its much longer window. Option d is incorrect because troponin I remains elevated for a shorter window than troponin T before declining to baseline. By this point it would likely have normalized, leaving troponin T as the only marker with a window long enough to confirm the event.

Correct Answer: It reduces the formation of blood clots

Daily aspirin decreases platelet aggregation, reducing the formation of clots that could cause a heart attack. This antiplatelet action is why it is recommended at the onset of chest pain along with nitroglycerin. Option a is incorrect because dissolving an existing clot is the job of thrombolytic drugs such as alteplase, not aspirin. Aspirin works by preventing new platelet clumping, so describing it as a clot-buster misstates how the medication actually protects the heart. Option b is incorrect because aspirin at this dose does not relieve ischemic chest pain; opioids such as morphine serve that role during an infarction. Its purpose is reducing platelet aggregation to prevent clot formation, not providing analgesia. Option c is incorrect because lowering the heart rate is an effect of beta-blockers like metoprolol, not of aspirin. Aspirin neither slows the heart nor affects exertional rate; it works solely by inhibiting platelet clumping to lower clot risk.

Correct Answer: Crackles and frothy sputum

Left-sided heart failure backs fluid up into the lungs, producing crackles and frothy, sometimes blood-tinged sputum. These pulmonary congestion signs distinguish left-sided failure from the systemic findings of right-sided failure. Option a is incorrect because jugular vein distention reflects systemic venous congestion from right-sided heart failure, not the pulmonary backup of left-sided failure. The lungs, not the neck veins, show the congestion when the left ventricle fails to pump forward. Option b is incorrect because dependent edema in the legs and ankles results from right-sided failure pushing fluid into the systemic circulation. Left-sided failure instead congests the lungs, so this peripheral finding belongs to the other side of the heart. Option d is incorrect because an enlarged liver and abdominal ascites are systemic signs of right-sided heart failure. They arise from venous congestion in the body, whereas left-sided failure manifests in the lungs with crackles and frot

Correct Answer: Place the client in high-Fowler's position

Placing the client in high-Fowler's position reduces preload and eases pulmonary congestion, directly relieving the shortness of breath. Following airway and breathing priorities, this intervention comes before weighing or further assessment. Option b is incorrect because weighing the client tracks fluid status over time but does nothing to relieve the immediate breathing difficulty. An intervention that improves ventilation right now takes precedence over collecting this baseline measurement. Option c is incorrect because auscultating the lungs gathers important data yet does not treat the present dyspnea. Under airway-breathing priorities, repositioning the client to ease congestion comes before assessment when breathing is compromised. Option d is incorrect because checking oxygen saturation provides a useful number but delays acting on the client's distress. Positioning in high-Fowler's actively improves breathing first, after which the nurse can obtain the saturatio

Correct Answer: I will eat foods high in potassium

Furosemide depletes potassium, and a low potassium level increases the risk of digoxin toxicity. Eating potassium-rich foods helps maintain a safe level, protecting the client from the dangerous toxicity that hypokalemia promotes. Option a is incorrect because limiting potassium is exactly wrong because furosemide already causes losses, and the resulting low level heightens digoxin toxicity. The client should increase potassium intake, not restrict it, to stay safe on these two medications together. Option b is incorrect because digoxin is held for a slow apical pulse, not a fast one. Watching for a rapid rate could lead the client to keep taking doses when bradycardia signals toxicity, so this reflects a misunderstanding of the parameter. Option c is incorrect because antacids interfere with digoxin absorption and should be separated by a couple of hours, not taken together. Combining them reduces the drug's effectiveness, making this statement an unsafe practice rather than corr

Correct Answer: Persistent cough with pink, frothy sputum

The hallmark of pulmonary edema is a persistent cough producing pink, frothy sputum as fluid floods the alveoli. This finding, with crackles and orthopnea, reflects the life-threatening fluid accumulation in the lungs. Option a is incorrect because thick yellow purulent sputum suggests a respiratory infection like pneumonia, not the fluid backup of pulmonary edema. The edema produces thin, pink, frothy secretions instead, reflecting plasma leaking into the alveoli rather than pus. Option b is incorrect because urine output actually decreases in pulmonary edema as cardiac output and renal perfusion fall. Expecting increased output reverses the true picture, since the failing heart cannot maintain adequate flow to the kidneys. Option d is incorrect because pulmonary edema produces tachycardia, not bradycardia, and the skin is typically cool and clammy. Warm dry skin with a slow heart rate contradicts the stressed, fluid-overloaded state this emergency creates.

Correct Answer: High-Fowler's with the legs dependent

High-Fowler's position with the legs hanging dependent pools blood in the lower extremities, decreasing venous return and preload. This reduces the volume the failing heart must handle and eases pulmonary congestion. Option a is incorrect because raising the legs while supine increases venous return to an already overloaded heart, worsening pulmonary congestion. The goal is to lower preload by keeping the legs dependent, the opposite of elevating them in this situation. Option c is incorrect because lying flat with the legs raised pushes more blood back to the heart and lets abdominal organs press on the diaphragm. Both effects intensify the congestion and breathing difficulty that the dependent-leg position is meant to relieve. Option d is incorrect because tilting the client head-down in Trendelenburg drives blood toward the chest, increasing preload and impairing ventilation. This is precisely the wrong direction for pulmonary edema, where reducing venous return to the heart is

Correct Answer: I will have my prothrombin time checked

A mechanical valve requires lifelong anticoagulation with warfarin, so the client must have prothrombin time and INR checked regularly. This monitoring keeps the dose in the therapeutic range and prevents clotting on the valve. Option a is incorrect because clients with prosthetic valves still need prophylactic antibiotics before dental and invasive procedures to prevent endocarditis. Believing antibiotics are no longer required would leave the client unprotected against a dangerous valve infection. Option b is incorrect because the dietary focus after valve surgery is limiting sodium, not increasing potassium. Raising potassium has no role here, so this statement reflects confusion about the actual nutritional teaching for a valve replacement client. Option c is incorrect because it is tissue valves, not mechanical ones, that wear out and eventually need replacement after years of use. A mechanical valve is durable but demands lifelong anticoagulation, which is the key teaching point

Correct Answer: Splinter hemorrhages and petechiae with fever

Infective endocarditis classically produces splinter hemorrhages, petechiae, fever, and a new murmur, along with positive blood cultures. These signs reflect organisms colonizing the endocardium and showering small emboli through the circulation. Option a is incorrect because chest pain relieved by sitting and leaning forward is the signature of pericarditis, the inflamed pericardium. This positional relief does not describe endocarditis, which presents instead with fever, petechiae, and the telltale splinter hemorrhages under the nails. Option c is incorrect because joint pain with a trunk and extremity rash points to rheumatic endocarditis following streptococcal infection. While related, this differs from infective endocarditis, whose hallmark findings are splinter hemorrhages and petechiae with fever and positive cultures. Option d is incorrect because a rapid heart rate with an enlarged heart suggests myocarditis, inflammation of the heart muscle. These features are not the emboli

Correct Answer: A pericardial friction rub

A pericardial friction rub is the characteristic finding in pericarditis, heard as the inflamed pericardial layers rub together. The associated chest pain typically worsens with breathing and eases when the client leans forward. Option a is incorrect because splinter hemorrhages are red streaks under the nails seen in infective endocarditis, not pericarditis. They result from tiny emboli, a mechanism unrelated to the rubbing of inflamed pericardial surfaces that produces a friction rub. Option b is incorrect because a rash spreading over the trunk and extremities is associated with rheumatic endocarditis after a streptococcal infection. It is not a feature of pericarditis, whose defining sign is the audible pericardial friction rub. Option c is incorrect because bounding pulses point to conditions like aortic insufficiency, not pericarditis. The expected pericarditis finding is the friction rub with positional chest pain, a sign generated by the inflamed pericardium rather than altered

Correct Answer: Angina and syncope on exertion

Aortic stenosis narrows the valve opening, limiting blood flow from the left ventricle. This produces angina, exertional syncope, dyspnea, and a narrowed pulse pressure as the obstructed outflow restricts cardiac output during activity. Option b is incorrect because a widened pulse pressure characterizes aortic insufficiency, where blood regurgitates back into the ventricle. Aortic stenosis instead narrows the pulse pressure because the tight valve limits forward flow, making this finding the wrong valve disorder. Option c is incorrect because a bounding Corrigan's pulse is a sign of aortic insufficiency from the rapid runoff of regurgitant blood. Stenosis produces a weak, late-rising pulse with a narrowed pulse pressure, not the bounding quality described here. Option d is incorrect because a diastolic murmur at the apex suggests mitral stenosis rather than aortic stenosis, which generates a systolic murmur. Aortic stenosis announces itself through exertional angina and syncope f

Correct Answer: Cardiac tamponade

Hypotension, jugular vein distention, muffled heart sounds, and a pulse that fades on inspiration form the classic picture of cardiac tamponade. Fluid in the pericardial sac compresses the heart, a medical emergency needing pericardiocentesis. Option a is incorrect because right-sided heart failure produces neck vein distention and edema but not muffled heart sounds or the marked inspiratory pulse drop. Those compressive findings point to fluid squeezing the heart in the pericardial sac, which failure alone does not cause. Option b is incorrect because aortic stenosis causes a systolic murmur with exertional angina and syncope, not the muffled sounds and paradoxical pulse seen here. The constellation described reflects pericardial compression rather than a narrowed valve obstructing outflow. Option c is incorrect because a pulmonary embolism brings sudden dyspnea and pleuritic chest pain from a blocked pulmonary vessel. It does not classically produce muffled heart sounds with a parado